Healthcare Provider Details

I. General information

NPI: 1225194194
Provider Name (Legal Business Name): DOHENY EYE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40055 BOB HOPE DR SUITE J
RANCHO MIRAGE CA
92270-3937
US

IV. Provider business mailing address

1450 SAN PABLO ST SUITE 3700
LOS ANGELES CA
90033-4500
US

V. Phone/Fax

Practice location:
  • Phone: 760-320-2133
  • Fax: 760-327-0495
Mailing address:
  • Phone: 323-442-7152
  • Fax: 323-442-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD E SMITH
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 323-442-6425