Provider Demographics
NPI:1124171566
Name:SEAL BEACH EYES OPTOMETRY INC
Entity type:Organization
Organization Name:SEAL BEACH EYES OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-431-2031
Mailing Address - Street 1:1190 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6247
Mailing Address - Country:US
Mailing Address - Phone:562-431-2031
Mailing Address - Fax:562-594-0479
Practice Address - Street 1:1190 PACIFIC COAST HWY
Practice Address - Street 2:SUITE E
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6247
Practice Address - Country:US
Practice Address - Phone:562-431-2031
Practice Address - Fax:562-594-0479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEAL BEACH EYES OPTOMETRY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB212827Medicare PIN