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General NPI Number Information
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NPI Number | 1417060245
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Entity Type | Organization
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Legal Business Name | OXNARD EYE ASSOCIATES MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 351 S B ST
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City | OXNARD
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State | CA
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Zip | 93030-5806
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Country | US
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Telephone | 805-240-1650
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Fax | 805-240-1953
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Provider Business Mailing Address
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Address Line | 17750 SHERMAN WAY., SUITE 100
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City | RESEDA
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State | CA
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Zip | 91335
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Country | US
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Telephone | 818-886-6700
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Fax | 818-886-6709
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. SANJAY LOGANI
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Credential | M.D.
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Telephone | 818-886-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT015370TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G73456
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License Number State | CA
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