=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750342622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATARACT AND CORNEA SURGICAL INSTITUTE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 01/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 W WHITTIER BLVD SUITE 100
-----------------------------------------------------
City | LA HABRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90631-3893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-694-2500
-----------------------------------------------------
Fax | 562-694-2577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 W WHITTIER BLVD SUITE 100
-----------------------------------------------------
City | LA HABRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90631-3893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-694-2500
-----------------------------------------------------
Fax | 562-694-2577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DEEP R DUDEJA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 562-694-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | G83764
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------