MEDICARE: CALIFORNIA CENTER FOR REFRACTIVE SURGERY

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	G77461	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

General Provider Information

NPI Number	:	1356761506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA CENTER FOR REFRACTIVE SURGERY

Provider Business Mailing Address
First Line	:	4160 WILSHIRE BLVD
Second Line	:	2ND FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3567
Country	:	US
Telephone Number	:	323-933-3111
Fax Number	:	323-933-3393

Provider Business Practice Location Address
First Line	:	4160 WILSHIRE BLVD
Second Line	:	2ND FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3567
Country	:	US
Telephone Number	:	323-933-3111
Fax Number	:	323-933-3393

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	PAUL C LEE
Credential	:
Telephone Number	:	323-933-3111

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	04/25/2014

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Directions to “CALIFORNIA CENTER FOR REFRACTIVE SURGERY ” Practice Location

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