MEDICARE: OPHTHALMIC HEALTH ALLIANCE 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

General Provider Information

NPI Number	:	1710618624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMIC HEALTH ALLIANCE INC

Provider Business Mailing Address
First Line	:	24355 CREEKSIDE RD UNIT 800817
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91380-7062
Country	:	US
Telephone Number	:	661-430-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 E CESAR E CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1168
Country	:	US
Telephone Number	:	323-980-9900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL URREA
Credential	:	MD
Telephone Number	:	323-980-9900

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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