Healthcare Provider Details

I. General information

NPI: 1750501383
Provider Name (Legal Business Name): OCULAR SURGERY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 BUENA VISTA ST SUITE 204
DUARTE CA
91010-1712
US

IV. Provider business mailing address

931 BUENA VISTA ST SUITE 204
DUARTE CA
91010-1712
US

V. Phone/Fax

Practice location:
  • Phone: 626-303-7788
  • Fax: 626-359-8912
Mailing address:
  • Phone: 626-303-7788
  • Fax: 626-359-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MALVIN D ANDERS
Title or Position: PARTNER
Credential: M.D.
Phone: 626-303-7788