MEDICARE: OXNARD EYE ASSOCIATES MEDICAL GROUP, INC.

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	152W00000X	Optometrist	OPT015370TLG	CA
2	207W00000X	Ophthalmology Physician	G73456	CA

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

General Provider Information

NPI Number	:	1417060245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OXNARD EYE ASSOCIATES MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	17750 SHERMAN WAY.,
Second Line	:	SUITE 100
City	:	RESEDA
State	:	CA
Zip	:	91335
Country	:	US
Telephone Number	:	818-886-6700
Fax Number	:	818-886-6709

Provider Business Practice Location Address
First Line	:	351 S B ST
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93030-5806
Country	:	US
Telephone Number	:	805-240-1650
Fax Number	:	805-240-1953

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. SANJAY LOGANI
Credential	:	M.D.
Telephone Number	:	818-886-6700

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	03/17/2018

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