MEDICARE: LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	S551044	CA

General Provider Information

NPI Number	:	1164406021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3300 E SOUTH ST
Second Line	:	SUITE 105
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4550
Country	:	US
Telephone Number	:	562-531-2020
Fax Number	:	562-531-1142

Provider Business Practice Location Address
First Line	:	3300 E SOUTH ST
Second Line	:	SUITE 105
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4550
Country	:	US
Telephone Number	:	562-531-2020
Fax Number	:	562-531-1142

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MRS. CAROLINE BARRAGAN
Credential	:
Telephone Number	:	562-531-2020

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	02/27/2009

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