Alvarado Eye Associates Med Clinic Inc
Organization Active NPI Multi-Specialty Clinic/Center · La Mesa, CA
NPI 1619973591 · NPPES record last updated Aug 21, 2023
Key facts
- NPI
- 1619973591
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- ALVARADO EYE ASSOCIATES MED CLINIC INC
- Practice address
- 7877 Parkway Dr.
Suite# 100
La Mesa, CA 91942-2000 - Phone
- (619) 460-3711
- Fax
- (619) 460-2184
- NPI assigned
- Jun 24, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Glen Cook, MD
- Title
- Owner
- Phone
- (619) 460-3711
Practitioners 9
-
Iga N Gray, MD, PHD
-
Lee Richard Katzman, M.D.
-
Joseph Daniel Mannen, O.D.
-
Jocelyn Ou, OD
-
Randall Earl Conrad, O.D.
-
Glenn Cook, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2275273 | Alvarado Eye Associates, Inc | Certificate of waiver | Jan 17, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Alvarado Eye Associates |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070216000198 | CA | Part B Supplier - Clinic/Group Practice | 0749382042 |
Receives reassigned benefits from 9 practitioners Practice locations: Coronado, CA; La Mesa, CA |
| O20110304000459 | CA | DME Supplier - Physician - Ophthalmology |
0749382042 | Practice locations: La Mesa, CA |
National Provider Directory
Locations
801 Orange Ave
Ste 204
Coronado, CA 92118
Phone (614) 460-3711
7877 Parkway Dr
Ste 100
La Mesa, CA 91942
Phone (619) 460-3711
5555 Reservoir Dr
Ste 300
San Diego, CA 92120
Phone (619) 286-3711
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | |||
| Ophthalmology Physician |
207W00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
7877 Parkway Dr.
Suite# 100
La Mesa, CA 91942-2000
Mailing address
75 Enterprise Ste 200
Aliso Viejo, CA 92656-2626
Phone (949) 688-6205
Other practice location 1
801 Orange Ave Ste 204
Coronado, CA 92118-2663
Phone (619) 460-3711
Other names
- Alvarado Eye Associates Medical Clinic Inc
Other providers in La Mesa, CA
- Ronda Alpatty
- Lindsey Stroben Alper
- Steven Alper
- Huda Y Alsheikh
- Kikelomo Aluko
- Alvarado-la Mesa Urology Medical Group Inc
- Christine Alvarenga
- Alwahab MD Inc
- Always There Mobile Physicians, Inc.
- Jayne Alzua
All providers in La Mesa, CA · Multi-Specialty Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.