Provider Demographics
NPI:1215089446
Name:EL DORADO HILLS EYECARE OPTOMETRY
Entity type:Organization
Organization Name:EL DORADO HILLS EYECARE OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:YOSHIKO
Authorized Official - Last Name:KINOSHITA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-939-6631
Mailing Address - Street 1:899 EMBARCADERO DR
Mailing Address - Street 2:STE 3
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4094
Mailing Address - Country:US
Mailing Address - Phone:916-939-6631
Mailing Address - Fax:
Practice Address - Street 1:899 EMBARCADERO DR
Practice Address - Street 2:STE 3
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4094
Practice Address - Country:US
Practice Address - Phone:916-939-6631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 2831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4508670001OtherMEDICARE SUPPLIER
CAZZZ23198ZMedicare ID - Type Unspecified