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General NPI Number Information
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NPI Number | 1033131933
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Entity Type | Organization
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Legal Business Name | PENINSULA EYECARE MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 800 S PACIFIC AVE STE A
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City | SAN PEDRO
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State | CA
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Zip | 90731-3267
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Country | US
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Telephone | 310-547-9991
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Fax | 310-547-2389
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Provider Business Mailing Address
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Address Line | 800 S PACIFIC AVE STE A
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City | SAN PEDRO
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State | CA
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Zip | 90731-3267
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Country | US
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Telephone | 310-547-9991
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Fax | 310-547-2389
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH JOEL MILLER
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Credential | MD
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Telephone | 310-547-9991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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