PENINSULA EYE SURGERY CENTER LLC NPI 1770652216

NPI Information

NPI: 1770652216
Provider Name: PENINSULA EYE SURGERY CENTER LLC
Classification: Clinic/Center - 261QS0132X
Entity Type: Organization

Specialization: Ophthalmologic Surgery

CLIA Number: 05D1043905

Address:
1128 W EL CAMINO REAL
MOUNTAIN VIEW, CA
ZIP 94040
Phone: (650) 964-3200
Get Directions

PENINSULA EYE SURGERY CENTER LLC is an ophthalmologic surgery clinic center in Mountain View, CA. PENINSULA EYE SURGERY CENTER LLC NPI is 1770652216. The provider is registered as an organization entity type.

The provider's business location address is:

1128 W EL CAMINO REAL
MOUNTAIN VIEW, CA
ZIP 94040-518
Phone: (650) 964-3200
Fax: (650) 964-3206

The provider's authorized official is Jeffrey M Fields .
The authorized official title is Vp and has the following contact phone number (205) 545-2572.

The CLIA number assigned to this NPI record is 05D1043905 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/7/2006 and was last updated on 8/21/2014.

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
1	261QA1903X	Clinic/Center	Ambulatory Surgical			No
2	261QS0132X	Clinic/Center	Ophthalmologic Surgery	550000072	CALIFORNIA	Yes

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
1	AS1737	OTHER		BLUE CROSS
2	SUR01737F	MEDICAID	CALIFORNIA
3	ZZZ318562Z	MEDICARE ID-TYPE UNSPECIFIED
4	05C0001737	MEDICARE ID-TYPE UNSPECIFIED

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: 5/5/2024

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