Healthcare Provider Details

I. General information

NPI: 1962508317
Provider Name (Legal Business Name): WESTLAKE EYE AND SKIN ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 LAKEVIEW CANYON RD 597
WESTLAKE VILLAGE CA
91361-4028
US

IV. Provider business mailing address

4607 LAKEVIEW CANYON RD 597
WESTLAKE VILLAGE CA
91361-4028
US

V. Phone/Fax

Practice location:
  • Phone: 818-497-7740
  • Fax: 818-991-1507
Mailing address:
  • Phone: 818-497-7740
  • Fax: 818-991-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC40477
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG48151
License Number StateCA

VIII. Authorized Official

Name: FRED A LINSTONE
Title or Position: MD OWNER
Credential: MD
Phone: 818-497-7740