1285860445 NPI number — WOLSTAN & GOLDBERG EYE ASSOCIATES INC A MEDICAL CORPORATON

Table of content: KEVIN DWAYNE ZWIENER D.C. (NPI 1053422584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285860445 NPI number — WOLSTAN & GOLDBERG EYE ASSOCIATES INC A MEDICAL CORPORATON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOLSTAN & GOLDBERG EYE ASSOCIATES INC A MEDICAL CORPORATON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285860445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23600 TELO AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90505-4035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-543-2611
Provider Business Mailing Address Fax Number:
310-543-2056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23600 TELO AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-543-2611
Provider Business Practice Location Address Fax Number:
310-543-2056
Provider Enumeration Date:
06/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WOLSTAN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-543-2611

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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