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NPI Code Detail

MEDICARE: EYE DEPARTMENT CORP

MEDICARE: EYE DEPARTMENT CORP
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
1152W00000XOptometristT005981NY

General Provider Information

NPI Number : 1629167291
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE DEPARTMENT CORP
Provider Business Mailing Address
First Line : 805 EMERALD ST
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3203
Country : US
Telephone Number : 917-796-4024
Fax Number :
Provider Business Practice Location Address
First Line : 805 EMERALD ST
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3203
Country : US
Telephone Number : 917-796-4024
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. M. CATARINA JANG
Credential : O.D.
Telephone Number : 917-796-4024
Provider Enumeration Date : 10/12/2006
Last Update Date : 02/12/2013

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Directions to “EYE DEPARTMENT CORP ” Practice Location

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