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General NPI Number Information
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NPI Number | 1356725816
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Entity Type | Organization
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Legal Business Name | LOS ANGELES OPHTHALMOLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 323 N PRAIRIE AVE SUITE 201
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City | INGLEWOOD
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State | CA
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Zip | 90301-4502
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Country | US
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Telephone | 310-673-5774
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Fax | 310-673-9729
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Provider Business Mailing Address
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Address Line | P.O. BOX 90619
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City | LOS ANGELES
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State | CA
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Zip | 90009-9998
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Country | US
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Telephone | 310-673-5774
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Fax | 310-673-9729
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD CASEY
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Credential | M.D.
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Telephone | 310-673-5774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | FNP40021
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License Number State | CA
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