Provider Demographics
NPI:1124068523
Name:EYE SURGICAL & MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:EYE SURGICAL & MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-627-9393
Mailing Address - Street 1:5021 W NOBLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8310
Mailing Address - Country:US
Mailing Address - Phone:559-627-9393
Mailing Address - Fax:559-627-1624
Practice Address - Street 1:5021 W NOBLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8310
Practice Address - Country:US
Practice Address - Phone:559-627-9393
Practice Address - Fax:559-627-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31645174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4999430001Medicare NSC
CAZZZ27758ZMedicare PIN