NPIMap

Organization Active NPI

Eyecare Specialists Medical Group, Inc.

  • Ophthalmology Physician
  • Laguna Hills, CA
National Provider Identifier
1487762159
Registry record updated Nov 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYECARE SPECIALISTS MEDICAL GROUP, INC.
Practice address
23521 Paseo de Valencia
Suite 305
Laguna Hills, CA 92653-3107
Phone
(949) 581-1770
Fax
(949) 454-2002
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2022

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

Authorized official

Name
Felisa Marisol Galindo
Title
Credentialing Supervisor
Phone
(626) 305-9100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

23521 Paseo de Valencia
Suite 305
Laguna Hills, CA 92653-3107

Mailing address

888 S Disneyland Dr
Suite 100
Anaheim, CA 92802-1847
Phone (714) 399-0678

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ65057ZOtherCABLUE SHIELD

Other names 1

  • Atlantis Eyecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040318000884 CA Part B Supplier - Clinic/Group Practice 2264322080 Receives reassigned benefits from 16 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Torrance, CA; Downey, CA; Santa Ana, CA; Palm Desert, CA; Montebello, CA; Laguna Hills, CA; Long Beach, CA; Anaheim, CA…
O20110714000319 CA DME Supplier - Physician - Ophthalmology 2264322080 Practice locations: Laguna Hills, CA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Eyecare Spec Med GRP10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23961 Calle de la Magdalena
Ste 412
Laguna Hills, CA 92653
Phone (949) 581-1770

Practitioners & affiliated clinicians

Practitioners 4

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": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1487762159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 S DISNEYLAND DR",
            "address_2": "SUITE 100",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928021847",
            "telephone_number": "714-399-0678",
            "fax_number": "714-276-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23521 PASEO DE VALENCIA",
            "address_2": "SUITE 305",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533107",
            "telephone_number": "949-581-1770",
            "fax_number": "949-454-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE SPECIALISTS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A",
        "authorized_official_last_name": "GALINDO",
        "authorized_official_first_name": "FELISA",
        "authorized_official_middle_name": "MARISOL",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "626-305-9100"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ65057Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantis Eyecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atlantis Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; 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.