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General NPI Number Information
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NPI Number | 1962602235
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Entity Type | Organization
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Legal Business Name | CHILDREN'S EYE CARE MEDICAL GROUP
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 3565 TORRANCE BLVD STE A
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City | TORRANCE
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State | CA
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Zip | 90503-4847
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Country | US
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Telephone | 310-543-1310
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Fax | 310-316-8148
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Provider Business Mailing Address
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Address Line | 3565 TORRANCE BLVD STE A
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City | TORRANCE
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State | CA
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Zip | 90503-4847
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Country | US
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Telephone | 310-543-1310
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Fax | 310-316-8148
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Authorized Official
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Title or Position | PEDIATRICS OPHTHALMOLOGY
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Name | MRS. ANNE SARAH SIMON
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Credential | M.D.
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Telephone | 310-543-1310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G81785
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License Number State | CA
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