Provider Demographics
NPI:1164503694
Name:JAMES H PEACE MD INC
Entity Type:Organization
Organization Name:JAMES H PEACE MD INC
Other - Org Name:DIABETIC EYE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HARMON
Authorized Official - Last Name:PEACE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:310-671-7172
Mailing Address - Street 1:431 N PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1413
Mailing Address - Country:US
Mailing Address - Phone:310-671-7172
Mailing Address - Fax:310-673-0682
Practice Address - Street 1:431 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1413
Practice Address - Country:US
Practice Address - Phone:310-671-7172
Practice Address - Fax:310-673-0682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6444Medicare PIN