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General NPI Number Information
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NPI Number | 1588852511
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Entity Type | Organization
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Legal Business Name | EYE SURGICAL MEDICAL GROUP, INC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 1211 N VERMONT AVE 200
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City | LOS ANGELES
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State | CA
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Zip | 90029-1748
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Country | US
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Telephone | 323-663-3333
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Fax | 323-661-1197
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Provider Business Mailing Address
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Address Line | 1211 N VERMONT AVE 200
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City | LOS ANGELES
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State | CA
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Zip | 90029-1748
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Country | US
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Telephone | 323-663-3333
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Fax | 323-661-1197
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH ESHAGIAN
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Credential | M.D.
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Telephone | 323-663-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number | G38640
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License Number State | CA
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