Provider Demographics
NPI:1699815076
Name:VALLEY EYE CARE MEDICAL GROUP INC
Entity type:Organization
Organization Name:VALLEY EYE CARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:760-344-4330
Mailing Address - Street 1:116 N PLAZA ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2426
Mailing Address - Country:US
Mailing Address - Phone:760-344-4330
Mailing Address - Fax:
Practice Address - Street 1:116 N PLAZA ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2426
Practice Address - Country:US
Practice Address - Phone:760-344-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG037837207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G378370Medicaid
CA0610560001Medicare NSC
CAW10595Medicare PIN
CAA89649Medicare UPIN