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General NPI Number Information
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NPI Number | 1265661821
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Entity Type | Organization
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Legal Business Name | CENTER FOR RETINAL AND MACULAR DISEASES, INC.
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Dates
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Enumeration Date | 07/04/2009
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 1440 AVOCADO AVENUE SUITE 204
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-721-1701
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Fax | 949-612-1910
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Provider Business Mailing Address
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Address Line | 1441 AVOCADO AVE SUITE 204
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7721
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Country | US
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Telephone | 949-500-3207
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Fax | 949-612-1910
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LEONID E. LERNER
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Credential | M.D., PH.D.
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Telephone | 949-500-3207
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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 | A54458
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License Number State | CA
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