Healthcare Provider Details

I. General information

NPI: 1497788277
Provider Name (Legal Business Name): PACIFIC EYE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 W BURBANK BLVD
BURBANK CA
91505-2300
US

IV. Provider business mailing address

2829 W BURBANK BLVD
BURBANK CA
91505-2300
US

V. Phone/Fax

Practice location:
  • Phone: 818-567-0348
  • Fax: 818-567-2859
Mailing address:
  • Phone: 818-567-0348
  • Fax: 818-567-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN BERG
Title or Position: MEMBER
Credential:
Phone: 818-845-6664