Healthcare Provider Details

I. General information

NPI: 1902971302
Provider Name (Legal Business Name): BEVERLY HILLS VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N BEDFORD DR SUITE 110
BEVERLY HILLS CA
90210-4324
US

IV. Provider business mailing address

450 N BEDFORD DR SUITE 110
BEVERLY HILLS CA
90210-4324
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-7888
  • Fax: 310-550-8999
Mailing address:
  • Phone: 310-550-7888
  • Fax: 310-550-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA85260
License Number StateCA

VIII. Authorized Official

Name: AFSHIN JAMES KHODABAKHSH
Title or Position: CEO
Credential: MD
Phone: 310-550-7888