MEDICARE: CENTURY EYE CARE MEDICAL CENTER, INC

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	207W00000X	Ophthalmology Physician	G83156	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184736357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTURY EYE CARE MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	1141 W REDONDO BEACH BLVD
Second Line	:	SUITE 101
City	:	GARDENA
State	:	CA
Zip	:	90247-3586
Country	:	US
Telephone Number	:	310-767-7814
Fax Number	:	310-323-3785

Provider Business Practice Location Address
First Line	:	1141 W REDONDO BEACH BLVD
Second Line	:	SUITE 101
City	:	GARDENA
State	:	CA
Zip	:	90247-3585
Country	:	US
Telephone Number	:	310-767-7814
Fax Number	:	310-323-3785

Authorized Official
Title or Position	:	BILLING&FINANCE EXECUTIVE ADMINISTR
Name	:	CYNTHIA GASCON
Credential	:
Telephone Number	:	310-767-7814

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/31/2025

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