Healthcare Provider Details

I. General information

NPI: 1790972693
Provider Name (Legal Business Name): OCULAR SURGERY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 801
LOS ANGELES CA
90017-4808
US

IV. Provider business mailing address

1245 WILSHIRE BLVD STE 801
LOS ANGELES CA
90017-4808
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-1184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ROSENE
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-706-9191