=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548351943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIKOU EYE SURGICAL & MEDICAL CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 06/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 W EULALIA ST STE 315
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-2852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-240-2242
-----------------------------------------------------
Fax | 818-240-2232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 W EULALIA ST STE 315
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-2852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-240-2242
-----------------------------------------------------
Fax | 818-240-2232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SAM N NIKOU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-240-2241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------