Provider Demographics
NPI:1811168594
Name:CALIFORNIA EYE CLINIC
Entity type:Organization
Organization Name:CALIFORNIA EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
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:925-754-2300
Mailing Address - Fax:
Practice Address - Street 1:2260 GLADSTONE DR STE 3
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5125
Practice Address - Country:US
Practice Address - Phone:925-427-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0128121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty