Provider Demographics
NPI:1427155969
Name:SUNSHINE EYE SERVICES
Entity type:Organization
Organization Name:SUNSHINE EYE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALSTON
Authorized Official - Last Name:HOUSEHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-483-4804
Mailing Address - Street 1:PO BOX 7422
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031-7422
Mailing Address - Country:US
Mailing Address - Phone:805-483-4804
Mailing Address - Fax:805-483-1304
Practice Address - Street 1:200 SOUTH A STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5717
Practice Address - Country:US
Practice Address - Phone:805-483-4804
Practice Address - Fax:805-483-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C289650Medicaid
CA00C289650Medicaid
CAW15162Medicare ID - Type Unspecified