Healthcare Provider Details

I. General information

NPI: 1982926531
Provider Name (Legal Business Name): MERCY EYE CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 09/09/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12480 WASHINGTON BLVD
WHITTIER CA
90602-1005
US

IV. Provider business mailing address

1700 E CESAR E CHAVEZ AVE STE 3400
LOS ANGELES CA
90033-2469
US

V. Phone/Fax

Practice location:
  • Phone: 844-211-5462
  • Fax: 562-866-1803
Mailing address:
  • Phone: 844-211-5462
  • Fax: 562-866-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA48969
License Number StateCA

VIII. Authorized Official

Name: DR. SANDEEP KHANNA
Title or Position: PRESIDENT
Credential: MD
Phone: 844-211-5462