Healthcare Provider Details

I. General information

NPI: 1659406445
Provider Name (Legal Business Name): PLAZA EYE & SURGERY CENTER, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S GRAND AVE #100
LOS ANGELES CA
90015-3067
US

IV. Provider business mailing address

1414 S GRAND AVE #100
LOS ANGELES CA
90015-3067
US

V. Phone/Fax

Practice location:
  • Phone: 213-749-5555
  • Fax: 213-749-5253
Mailing address:
  • Phone: 213-749-5555
  • Fax: 213-749-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberC30903
License Number StateTN

VIII. Authorized Official

Name: MATTHEW A. BERNSTEIN
Title or Position: OPHTHALMOLOGIST AND OWNER
Credential: M.D.
Phone: 213-749-5555