CUSTOM EYES OPTOMETRY INC. NPI 1548472921

NPI Information

  • NPI: 1548472921
  • Provider Name: CUSTOM EYES OPTOMETRY, INC.
  • Classification: Optometrist - 152W00000X
  • Entity Type: Organization
  • Address: 1835 NEWPORT BLVD
    SUITE A-111
    COSTA MESA, CA
    ZIP 92627
  • Phone: (949) 646-4949

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NPI Details

CUSTOM EYES OPTOMETRY, INC. is an optometrist in Costa Mesa, CA. The provider is doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. CUSTOM EYES OPTOMETRY, INC. NPI is 1548472921. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1835 NEWPORT BLVD
SUITE A-111
COSTA MESA, CA
ZIP 92627-031
Phone: (949) 646-4949
Fax: (949) 646-2533

The provider's authorized official is Michael Paul Bourgoin .
The authorized official title is President and has the following contact phone number (949) 646-4949.

The enumeration date for this NPI number is 5/5/2007 and was last updated on 3/24/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1152W00000XOptometrist9870TCALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11720197361OTHERCALIFORNIAINDIVIDUAL NPI
2U77003MEDICARE UPINCALIFORNIA
3W19780MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAMEDICARE GROUP ID#

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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