Provider Demographics
NPI:1417776253
Name:ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRIAR
Authorized Official - Middle Name:RAMI
Authorized Official - Last Name:ZARNEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-925-2637
Mailing Address - Street 1:910 E STOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7001
Mailing Address - Country:US
Mailing Address - Phone:805-925-2637
Mailing Address - Fax:
Practice Address - Street 1:689 TANK FARM RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7078
Practice Address - Country:US
Practice Address - Phone:805-781-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty