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General NPI Number Information
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NPI Number | 1275631434
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Entity Type | Organization
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Legal Business Name | LOS ANGELES INSTITUTE FOR OPHTHALMIC SURGERY
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 5363 BALBOA BLVD SUITE 545
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City | ENCINO
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State | CA
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Zip | 91316-2805
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Country | US
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Telephone | 818-906-2929
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Fax | 818-906-0567
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Provider Business Mailing Address
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Address Line | 5363 BALBOA BLVD SUITE 545
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City | ENCINO
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State | CA
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Zip | 91316-2805
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Country | US
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Telephone | 818-906-2929
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Fax | 818-906-0567
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID MICHAEL COLVARD
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Credential | M.D.
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Telephone | 818-906-2929
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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 | G39377
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License Number State | CA
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