NPIMap

Organization Active NPI

Desert Ophthalmology Medical Corporation

  • Ophthalmology Physician
  • Palm Desert, CA
National Provider Identifier
1699392506
Registry record updated Jun 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
DESERT OPHTHALMOLOGY MEDICAL CORPORATION
Practice address
72650 Fred Waring Dr Ste 109
Palm Desert, CA 92260-5008
Phone
(760) 776-8600
NPI assigned
Jun 26, 2020
Last updated
Jun 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2020

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

Authorized official

Name
Dr. Wallace Franklin Goldban, MDNPI 1780872671
Title
Practice Owner
Phone
(760) 320-8497

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

72650 Fred Waring Dr Ste 109
Palm Desert, CA 92260-5008

Mailing address

72650 Fred Waring Dr Ste 109
Palm Desert, CA 92260-5008
Phone (760) 776-8600

National Provider Directory

National Provider Directory
Tax ID family
Desert Ophthalmology Medical Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1180 N Indian Canyon Dr
Ste W100
Palm Springs, CA 92262
Phone (760) 320-8497

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593129600000",
    "number": "1699392506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72650 FRED WARING DR STE 109",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922605008",
            "telephone_number": "760-776-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72650 FRED WARING DR STE 109",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922605008",
            "telephone_number": "760-776-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT OPHTHALMOLOGY MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-26",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A",
        "authorized_official_last_name": "GOLDBAN",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "FRANKLIN",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "760-320-8497",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Desert, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; 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.