Healthcare Provider Details

I. General information

NPI: 1881224210
Provider Name (Legal Business Name): CALIFORNIA LASIK AND CATARACT INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18632 BEACH BLVD STE 100
HUNTINGTON BEACH CA
92648-2047
US

IV. Provider business mailing address

18632 BEACH BLVD STE 100
HUNTINGTON BEACH CA
92648-2047
US

V. Phone/Fax

Practice location:
  • Phone: 714-962-3633
  • Fax: 714-962-3693
Mailing address:
  • Phone: 714-962-3633
  • Fax: 714-962-3693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BAVAND YOUSSEFZADEH
Title or Position: PARTNER
Credential: DO
Phone: 817-714-4283