Provider Demographics
NPI:1295740991
Name:EYE CARE INSTITUTE, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:EYE CARE INSTITUTE, A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ABRAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-763-6400
Mailing Address - Street 1:3035 CLEVELAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2122
Mailing Address - Country:US
Mailing Address - Phone:707-545-3800
Mailing Address - Fax:707-528-4967
Practice Address - Street 1:3035 CLEVELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2122
Practice Address - Country:US
Practice Address - Phone:707-545-3800
Practice Address - Fax:707-528-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-07-09
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
CASD0098571Medicaid
CAZZZ76363ZMedicaid
CA00G620850Medicare PIN
0399240001Medicare NSC
CAZZZ76363ZMedicare PIN
CA180042403Medicare PIN
CA00G343820Medicare PIN
CA00G493740Medicare PIN
U25600Medicare UPIN
F13493Medicare UPIN
CAZZZ76363ZMedicaid
CASD0098571Medicaid
CASD0098570Medicare PIN
CA180036143Medicare PIN
CA180014573Medicare PIN
CA00G608280Medicare PIN
F12164Medicare UPIN
CACS5700Medicare PIN
A45905Medicare UPIN
CA410043804Medicare PIN