Provider Demographics
NPI:1093139586
Name:JULES STEIN EYE INSTITUTE MEDICAL GROUP
Entity Type:Organization
Organization Name:JULES STEIN EYE INSTITUTE MEDICAL GROUP
Other - Org Name:DOHENY EYE CENTER UCLA-ARCADIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:BARTLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONDINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-206-0485
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-825-5000
Mailing Address - Fax:
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7606
Practice Address - Country:US
Practice Address - Phone:310-206-0485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty