Provider Demographics
NPI:1689184004
Name:ORLANDO CAMACHO, OD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ORLANDO CAMACHO, OD, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-352-1090
Mailing Address - Street 1:7521 OAKFORD CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8874
Mailing Address - Country:US
Mailing Address - Phone:909-899-5317
Mailing Address - Fax:
Practice Address - Street 1:2051 GALLERIA AT TYLER
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4143
Practice Address - Country:US
Practice Address - Phone:951-352-1993
Practice Address - Fax:951-352-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0091611Medicaid