Provider Demographics
NPI:1275566267
Name:LOS ANGELES VISION CENTER, INC.
Entity Type:Organization
Organization Name:LOS ANGELES VISION CENTER, INC.
Other - Org Name:LOS ANGELES VISION CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIVOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-838-0202
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2732
Mailing Address - Country:US
Mailing Address - Phone:310-838-0202
Mailing Address - Fax:310-838-8694
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:310-838-0202
Practice Address - Fax:310-838-8694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66738ZOtherBLUE SHIELD PROVIDER NUMB
CAW19615Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER