Healthcare Provider Details

I. General information

NPI: 1164406021
Provider Name (Legal Business Name): LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E SOUTH ST SUITE 105
LONG BEACH CA
90805-4550
US

IV. Provider business mailing address

3300 E SOUTH ST SUITE 105
LONG BEACH CA
90805-4550
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-2020
  • Fax: 562-531-1142
Mailing address:
  • Phone: 562-531-2020
  • Fax: 562-531-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberS551044
License Number StateCA

VIII. Authorized Official

Name: MRS. CAROLINE BARRAGAN
Title or Position: CREDENTIALING
Credential:
Phone: 562-531-2020