Provider Demographics
NPI:1215928775
Name:CALIFORNIA'S ADVANCED INSTITUTE OF VISION MEDICAL GROUP, INC
Entity type:Organization
Organization Name:CALIFORNIA'S ADVANCED INSTITUTE OF VISION MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:209-474-2121
Mailing Address - Street 1:1801 E MARCH LANE C350
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6674
Mailing Address - Country:US
Mailing Address - Phone:209-474-2121
Mailing Address - Fax:209-474-1181
Practice Address - Street 1:1801 E MARCH LANE C350
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6674
Practice Address - Country:US
Practice Address - Phone:209-474-2121
Practice Address - Fax:209-474-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094060Medicaid
CAGR0094060Medicaid