Healthcare Provider Details

I. General information

NPI: 1437298759
Provider Name (Legal Business Name): IRA E OPATOWSKY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42543 8TH ST W STE 101
LANCASTER CA
93534-7200
US

IV. Provider business mailing address

42543 8TH ST W STE 101
LANCASTER CA
93534-7200
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-4373
  • Fax: 661-948-6216
Mailing address:
  • Phone: 661-948-4373
  • Fax: 661-948-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL GUZMAN
Title or Position: BILLER
Credential:
Phone: 661-948-4373