Provider Demographics
NPI:1073875472
Name:GLAUCOMA INSTITUTE OF BEVERLY HILLS
Entity Type:Organization
Organization Name:GLAUCOMA INSTITUTE OF BEVERLY HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-855-1112
Mailing Address - Street 1:8733 BEVERLY BLVD SUITE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1800
Mailing Address - Country:US
Mailing Address - Phone:310-855-1112
Mailing Address - Fax:310-855-1211
Practice Address - Street 1:8733 BEVERLY BLVD SUITE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1800
Practice Address - Country:US
Practice Address - Phone:310-855-1112
Practice Address - Fax:310-855-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31961AMedicare PIN