Provider Demographics
NPI:1164893236
Name:SWARAJ BOSE, MD, INC
Entity Type:Organization
Organization Name:SWARAJ BOSE, MD, INC
Other - Org Name:NEUROEYEORBIT INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SWARAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-469-9080
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-469-9080
Mailing Address - Fax:310-469-9085
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 200E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-469-9080
Practice Address - Fax:310-469-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB246527Medicare UPIN
CAG86517Medicare UPIN
W19615Medicare UPIN
CAWA65554EMedicare PIN