Provider Demographics
NPI:1427258755
Name:ERWIN M OMENS MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ERWIN M OMENS MD A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OMENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-745-9500
Mailing Address - Street 1:810 E OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3421
Mailing Address - Country:US
Mailing Address - Phone:760-745-9500
Mailing Address - Fax:760-746-3991
Practice Address - Street 1:810 E OHIO AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3421
Practice Address - Country:US
Practice Address - Phone:760-745-9500
Practice Address - Fax:760-746-3991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERWIN M OMENS MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-24
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38629207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty