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General NPI Number Information
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NPI Number | 1487049185
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Entity Type | Organization
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Legal Business Name | DOCTOR RETINA
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 8383 WILSHIRE BLVD STE 440
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2436
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Country | US
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Telephone | 310-571-5026
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Fax | 844-373-8462
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Provider Business Mailing Address
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Address Line | 8383 WILSHIRE BLVD STE 440 SUITE 440
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2436
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Country | US
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Telephone | 310-571-5026
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Fax | 844-373-8462
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. MAZIAR LALEZARY
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Credential | MD
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Telephone | 310-571-5026
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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 | A120462
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License Number State | CA
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