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General NPI Number Information
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NPI Number | 1124485784
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Entity Type | Organization
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Legal Business Name | SAN DIEGO EYELID SPECIALISTS, INC.
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 477 N EL CAMINO REAL A304
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City | ENCINITAS
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State | CA
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Zip | 92024-1328
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Country | US
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Telephone | 858-432-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 477 N EL CAMINO REAL A304
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City | ENCINITAS
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State | CA
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Zip | 92024-1328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | SRINIVAS IYENGAR
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Credential | M.D.
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Telephone | 760-456-9462
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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 | A105824
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License Number State | CA
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