=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629274337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTURY EYE CARE MEDICAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4477 W 118TH ST STE 101
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-2255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-644-8877
-----------------------------------------------------
Fax | 310-644-8870
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1141 W REDONDO BEACH BLVD STE 101
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-3585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-767-7814
-----------------------------------------------------
Fax | 310-323-3785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE EXECUTIVE ADMINISTRATOR
-----------------------------------------------------
Name | CYNTHIA GASCON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-767-7814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | G83156
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------