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General NPI Number Information
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NPI Number | 1912058728
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Entity Type | Organization
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Legal Business Name | A CENTER FOR VISIONCARE SURGICAL & MEDICAL GROUP
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 2031 W ALAMEDA AVE STE 300
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City | BURBANK
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State | CA
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Zip | 91506-2960
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Country | US
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Telephone | 818-762-0647
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Fax | 818-762-7834
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Provider Business Mailing Address
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Address Line | 4418 VINELAND AVE 106
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-3457
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Country | US
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Telephone | 818-762-0647
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Fax | 818-762-7834
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. DANA I TANNENBAUM
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Credential | M.D.
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Telephone | 818-762-0647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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