Healthcare Provider Details

I. General information

NPI: 1861783599
Provider Name (Legal Business Name): EYELID INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41990 COOK ST SUITE F1007
PALM DESERT CA
92211-6100
US

IV. Provider business mailing address

41990 COOK ST SUITE F1007
PALM DESERT CA
92211-6100
US

V. Phone/Fax

Practice location:
  • Phone: 760-610-2677
  • Fax: 760-610-6101
Mailing address:
  • Phone: 760-610-2677
  • Fax: 760-610-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA115818
License Number StateCA

VIII. Authorized Official

Name: DR. JENNIFER HUI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-610-2677