Provider Demographics
NPI:1598192163
Name:CALIFORNIA EYE CLINIC
Entity type:Organization
Organization Name:CALIFORNIA EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROSSERODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-754-2625
Mailing Address - Street 1:PO BOX 2539
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-2539
Mailing Address - Country:US
Mailing Address - Phone:925-754-2625
Mailing Address - Fax:925-755-8506
Practice Address - Street 1:301 LENNON LN
Practice Address - Street 2:SUITE 201
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2483
Practice Address - Country:US
Practice Address - Phone:925-932-1123
Practice Address - Fax:925-932-8650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies