1922164433 NPI number — OCULAR INSTITUTE OF CALIFORNIA, A MEDICAL CORPORATION

Table of content: (NPI 1922164433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922164433 NPI number — OCULAR INSTITUTE OF CALIFORNIA, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCULAR INSTITUTE OF CALIFORNIA, A MEDICAL CORPORATION
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:
6
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:
1922164433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEMEAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91770-0708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-485-4007
Provider Business Mailing Address Fax Number:
626-226-4024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9428 VALLEY BLVD. STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEMEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91770-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-350-6776
Provider Business Practice Location Address Fax Number:
626-350-3353
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MA
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
SHUOH-TYNG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-485-4007

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  A62421 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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