MEDICARE: RETINA CONSULTANTS OF LOS ANGELES, 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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1649298670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA CONSULTANTS OF LOS ANGELES, INC.

Provider Business Mailing Address
First Line	:	1808 VERDUGO BLVD
Second Line	:	SUITE 206
City	:	GLENDALE
State	:	CA
Zip	:	91208-1412
Country	:	US
Telephone Number	:	818-790-7611
Fax Number	:	818-952-5634

Provider Business Practice Location Address
First Line	:	1808 VERDUGO BLVD
Second Line	:	SUITE 206
City	:	GLENDALE
State	:	CA
Zip	:	91208-1412
Country	:	US
Telephone Number	:	818-790-7611
Fax Number	:	818-952-5634

Authorized Official
Title or Position	:	PRESIDENT AND DOCTOR
Name	:	DR. VINH TAN TRAN
Credential	:	M.D., PH.D.
Telephone Number	:	818-790-7611

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/26/2024

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