Healthcare Provider Details

I. General information

NPI: 1629107164
Provider Name (Legal Business Name): HULL EYE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 W AVENUE J
LANCASTER CA
93534-2703
US

IV. Provider business mailing address

1739 W AVENUE J
LANCASTER CA
93534-2703
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-4502
  • Fax:
Mailing address:
  • Phone: 661-945-4502
  • Fax:

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. REGINALD SAMPSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-945-4502