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Retina Consultants of Orange County, a Medical Corporation

Organization Active NPI Retina Specialist (Ophthalmology) Physician · Fullerton, CA

NPI 1770539702 · NPPES record last updated Mar 4, 2022

Key facts

NPI
1770539702
Entity type
Organization (NPI type 2)
Primary specialty
Retina Specialist (Ophthalmology) Physician 207WX0107X
License
G32479 (CA)
Legal business name
RETINA CONSULTANTS OF ORANGE COUNTY, A MEDICAL CORPORATION
Practice address
301 W Bastanchury Rd
285
Fullerton, CA 92835-3419
Phone
(714) 738-4620
Fax
(714) 738-0388
NPI assigned
May 25, 2006
Organization subpart
No

Authorized official

Name
Dr. Scott Grant, M.D.
Title
President
Phone
(714) 738-4620

Practitioners 10

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2117777Retina Consultants of Orange County
301 W Bastanchury Rd Ste 275, Fullerton, CA 92835		Certificate of waiverFeb 6, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031229000212 CA Part B Supplier - Clinic/Group Practice 8921906017 Receives reassigned benefits from 10 practitioners
Practice locations: Whittier, CA; Long Beach, CA; West Covina, CA; Fullerton, CA; Los Alamitos, CA

National Provider Directory

Locations

1045 Atlantic Ave
Ste 1008
Long Beach, CA 90813
Phone (562) 431-7345

3771 Katella Ave
Ste 208
Los Alamitos, CA 90720
Phone (562) 431-7345

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD
    Plans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • Direct secure messaging: csuplee@rcoc.intellechartdirect.net
  • Direct secure messaging: cng@rcoc.intellechartdirect.net
  • Direct secure messaging: sadrean@rcoc.intellechartdirect.net
  • Direct secure messaging: apirouz@rcoc.intellechartdirect.net
  • Direct secure messaging: hramkumar@rcoc.intellechartdirect.net
  • Direct secure messaging: sgrant@rcoc.intellechartdirect.net
  • Direct secure messaging: ilee@rcoc.intellechartdirect.net

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207WX0107X G32479 CA Yes

Addresses

Primary practice location

301 W Bastanchury Rd
285
Fullerton, CA 92835-3419

Mailing address

301 W Bastanchury Rd
285
Fullerton, CA 92835-3419
Phone (714) 738-4620

Other providers in Fullerton, CA

All providers in Fullerton, CA · Retina Specialist (Ophthalmology) Physician in California

Sources for this page

Verify at the official NPI Registry.