MEDICARE: EYE SURGICAL CENTER, LP

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	261QA1903X	Ambulatory Surgical Clinic/Center		CA

General Provider Information

NPI Number	:	1447285382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE SURGICAL CENTER, LP

Provider Business Mailing Address
First Line	:	855 W FOOTHILL BLVD
Second Line	:
City	:	MONROVIA
State	:	CA
Zip	:	91016-1938
Country	:	US
Telephone Number	:	626-305-9100
Fax Number	:	626-305-9150

Provider Business Practice Location Address
First Line	:	1809 VERDUGO BLVD
Second Line	:	STE 140
City	:	GLENDALE
State	:	CA
Zip	:	91208-1402
Country	:	US
Telephone Number	:	818-790-7874
Fax Number	:	818-790-4529

Authorized Official
Title or Position	:	OWNER/GENERAL PARTNER
Name	:	DR. MARCUS J LEMELY
Credential	:	M.D.
Telephone Number	:	626-305-9100

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/27/2022

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