Healthcare Provider Details

I. General information

NPI: 1629274337
Provider Name (Legal Business Name): CENTURY EYE CARE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 W 118TH ST STE 101
HAWTHORNE CA
90250-2255
US

IV. Provider business mailing address

1141 W REDONDO BEACH BLVD STE 101
GARDENA CA
90247-3585
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-8877
  • Fax: 310-644-8870
Mailing address:
  • Phone: 310-767-7814
  • Fax: 310-323-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG83156
License Number StateCA

VIII. Authorized Official

Name: CYNTHIA GASCON
Title or Position: FINANCE EXECUTIVE ADMINISTRATOR
Credential:
Phone: 310-767-7814