Provider Demographics
NPI:1073601001
Name:DOUGLAS L STEEL MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DOUGLAS L STEEL MD A PROFESSIONAL CORPORATION
Other - Org Name:ADVANCED SIGHT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-987-5300
Mailing Address - Street 1:321 N LARCHMONT BLVD
Mailing Address - Street 2:STE 1021
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6410
Mailing Address - Country:US
Mailing Address - Phone:323-466-7337
Mailing Address - Fax:323-962-9753
Practice Address - Street 1:321 N LARCHMONT BLVD
Practice Address - Street 2:STE 1021
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6410
Practice Address - Country:US
Practice Address - Phone:323-466-7337
Practice Address - Fax:323-962-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051434Medicare ID - Type UnspecifiedOUT PATIET FACILITY