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General NPI Number Information
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NPI Number | 1356761506
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CENTER FOR REFRACTIVE SURGERY
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 4160 WILSHIRE BLVD 2ND FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90010-3567
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Country | US
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Telephone | 323-933-3111
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Fax | 323-933-3393
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Provider Business Mailing Address
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Address Line | 4160 WILSHIRE BLVD 2ND FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90010-3567
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Country | US
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Telephone | 323-933-3111
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Fax | 323-933-3393
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | PAUL C LEE
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Credential |
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Telephone | 323-933-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G77461
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License Number State | CA
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