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NPI Code Detail

MEDICARE: EYE PHYSICIANS OF LONG BEACH A MEDICAL GROUP INC.

MEDICARE: EYE PHYSICIANS OF LONG BEACH A MEDICAL GROUP 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
1207W00000XOphthalmology PhysicianG84806CA
2152W00000XOptometristOPT8329TPACA
3207W00000XOphthalmology PhysicianA68745CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11952369399OTHERCANPI
21710093083OTHERCANPI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235231598
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE PHYSICIANS OF LONG BEACH A MEDICAL GROUP INC.
Provider Business Mailing Address
First Line : 2925 PALO VERDE AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-1552
Country : US
Telephone Number : 562-421-2757
Fax Number : 562-420-7267
Provider Business Practice Location Address
First Line : 2925 PALO VERDE AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-1552
Country : US
Telephone Number : 562-421-2757
Fax Number : 562-420-7267
Authorized Official
Title or Position : OWNER
Name : CARLOS ENRIQUE MARTINEZ
Credential : MD
Telephone Number : 562-421-2757
Provider Enumeration Date : 09/05/2006
Last Update Date : 08/24/2021

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