Provider Demographics
NPI:1992884522
Name:JOSEPH JESS ESTRADA, A P O C
Entity type:Organization
Organization Name:JOSEPH JESS ESTRADA, A P O C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JESS
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-757-4500
Mailing Address - Street 1:311 PAJARO ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3421
Mailing Address - Country:US
Mailing Address - Phone:831-757-4500
Mailing Address - Fax:831-757-4509
Practice Address - Street 1:311 PAJARO ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3421
Practice Address - Country:US
Practice Address - Phone:831-757-4500
Practice Address - Fax:831-757-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8713T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992884522Medicaid
CA1992884522Medicaid
CAU25406Medicare UPIN
CA4282350001Medicare NSC