NPIMap

Organization Active NPI

Eyecare Specialists Medical Group, Inc

  • Ophthalmology Physician
  • Huntington Beach, CA
National Provider Identifier
1669246104
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYECARE SPECIALISTS MEDICAL GROUP, INC
Practice address
7677 Center Ave Ste 102
Huntington Beach, CA 92647-3030
Phone
(714) 316-0802
Fax
(714) 316-0804
NPI assigned
Nov 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Authorized official

Name
Dwayne K LoganNPI 1164520714
Title
Medical Director
Phone
(562) 938-9945

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

7677 Center Ave Ste 102
Huntington Beach, CA 92647-3030

Mailing address

14726 Ramona Ave Ste 203
Chino, CA 91710-5730
Phone (626) 305-9100

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

14726 Ramona Ave
Ste 203
Chino, CA 91710
Phone (626) 305-9100

7677 Center Ave
Ste 102
Huntington Beach, CA 92647
Phone (714) 316-0802

Practitioners & affiliated clinicians

Practitioners 1

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": "1699920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1669246104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14726 RAMONA AVE STE 203",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917105730",
            "telephone_number": "626-305-9100",
            "fax_number": "626-305-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7677 CENTER AVE STE 102",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473030",
            "telephone_number": "714-316-0802",
            "fax_number": "714-316-0804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE SPECIALISTS MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "562-938-9945"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.