MEDICARE: DOHENY EYE MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	ZZZ7157Z	OTHER	CA	BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134159148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOHENY EYE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1450 SAN PABLO ST
Second Line	:	SUITE 3700
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-4500
Country	:	US
Telephone Number	:	323-442-7155
Fax Number	:	323-442-7158

Provider Business Practice Location Address
First Line	:	1450 SAN PABLO ST
Second Line	:	SUITE 4000
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-4500
Country	:	US
Telephone Number	:	323-442-7155
Fax Number	:	323-442-7158

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD E SMITH
Credential	:	M.D.
Telephone Number	:	323-442-6425

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	02/26/2008

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Directions to “DOHENY EYE MEDICAL GROUP ” Practice Location

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