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General NPI Number Information
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NPI Number | 1235231598
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Entity Type | Organization
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Legal Business Name | EYE PHYSICIANS OF LONG BEACH A MEDICAL GROUP INC.
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 2925 PALO VERDE AVE
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City | LONG BEACH
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State | CA
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Zip | 90815-1552
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Country | US
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Telephone | 562-421-2757
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Fax | 562-420-7267
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Provider Business Mailing Address
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Address Line | 2925 PALO VERDE AVE
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City | LONG BEACH
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State | CA
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Zip | 90815-1552
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Country | US
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Telephone | 562-421-2757
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Fax | 562-420-7267
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS ENRIQUE MARTINEZ
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Credential | MD
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Telephone | 562-421-2757
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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 | G84806
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT8329TPA
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A68745
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License Number State | CA
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