Provider Demographics
NPI:1265658694
Name:COMPLETE EYE CARE CENTER
Entity Type:Organization
Organization Name:COMPLETE EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-370-7575
Mailing Address - Street 1:17001 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3302
Mailing Address - Country:US
Mailing Address - Phone:310-370-7575
Mailing Address - Fax:310-370-6227
Practice Address - Street 1:17001 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3302
Practice Address - Country:US
Practice Address - Phone:310-370-7575
Practice Address - Fax:310-370-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03621156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9231OtherMEDICAL EYE SERVICES
CADX006426FMedicaid