Provider Demographics
NPI:1730402132
Name:ALLIED GARDENS FAMILY OPTOMETRY INC.
Entity type:Organization
Organization Name:ALLIED GARDENS FAMILY OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:619-583-1000
Mailing Address - Street 1:5175 WARING RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2705
Mailing Address - Country:US
Mailing Address - Phone:619-583-1000
Mailing Address - Fax:619-229-1938
Practice Address - Street 1:5175 WARING RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2705
Practice Address - Country:US
Practice Address - Phone:619-583-1000
Practice Address - Fax:619-229-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12360T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV09899Medicare UPIN
CA5776100001Medicare NSC
CACZ782AMedicare PIN