NPIMap

Organization Active NPI

Tri-County Eye Institute Inc

  • Ophthalmology Physician
  • Corona, CA
National Provider Identifier
1124156120
Registry record updated May 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
TRI-COUNTY EYE INSTITUTE INC
Practice address
1124 S Main St
# 101
Corona, CA 92882-4449
Phone
(951) 737-6363
Fax
(951) 272-6723
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracey L Gonciarczyk
Title
Billing Lead
Phone
(951) 737-6363

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1124 S Main St
# 101
Corona, CA 92882-4449

Mailing address

1124 S Main St
# 101
Corona, CA 92882-4449
Phone (951) 737-6363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090504000098 CA Part B Supplier - Clinic/Group Practice 6305994294 Receives reassigned benefits from 7 practitioners
Practice locations: Corona, CA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

2641 Hamner Ave
Ste 105
Norco, CA 92860
Phone (951) 737-6363

Interoperability endpoints

  • Direct secure messaging: jtruong@tcei.intellechartdirect.net
  • Direct secure messaging: sschneider-johnson@tcei.intellechartdirect.net
  • Direct secure messaging: klim@tcei.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241395200000",
    "number": "1124156120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 S MAIN ST",
            "address_2": "# 101",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928824449",
            "telephone_number": "951-737-6363",
            "fax_number": "951-272-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 S MAIN ST",
            "address_2": "# 101",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928824449",
            "telephone_number": "951-737-6363",
            "fax_number": "951-272-6723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY EYE INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2009-05-04",
        "status": "A",
        "authorized_official_last_name": "GONCIARCZYK",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING LEAD",
        "authorized_official_telephone_number": "951-737-6363"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.