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NPI Code Detail

MEDICARE: PARADIGM VISION CARE MEDICAL ASSOCIATES

MEDICARE: PARADIGM VISION CARE MEDICAL ASSOCIATES
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
1174400000XSpecialist

General Provider Information

NPI Number : 1780606673
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARADIGM VISION CARE MEDICAL ASSOCIATES
Provider Business Mailing Address
First Line : 301 N PRAIRIE AVE
Second Line : SUITE 601
City : INGLEWOOD
State : CA
Zip : 90301-4507
Country : US
Telephone Number : 310-673-2020
Fax Number : 310-671-6785
Provider Business Practice Location Address
First Line : 10300 COMPTON AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90002-3628
Country : US
Telephone Number : 310-673-2020
Fax Number : 310-671-6785
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIE BENTON BOONE
Credential : M.D.
Telephone Number : 310-673-2020
Provider Enumeration Date : 07/23/2006
Last Update Date : 08/22/2020

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