Provider Demographics
NPI:1932580198
Name:EYECARE MEDICAL CORPORATION
Entity type:Organization
Organization Name:EYECARE MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-384-5222
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-0190
Mailing Address - Country:US
Mailing Address - Phone:714-228-1888
Mailing Address - Fax:
Practice Address - Street 1:19038 NORWALK BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-7032
Practice Address - Country:US
Practice Address - Phone:562-653-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-13
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A621580Medicaid
CA00621580Medicaid
CACB225719Medicare PIN
CA00621580Medicaid
CA00A621580Medicaid
CA4939200002Medicare NSC
H33983Medicare UPIN