Provider Demographics
NPI:1316218621
Name:NEW VISION MEDICAL GROUP INC PROFESSIONAL CORP
Entity Type:Organization
Organization Name:NEW VISION MEDICAL GROUP INC PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-360-7690
Mailing Address - Street 1:8484 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3227
Mailing Address - Country:US
Mailing Address - Phone:310-360-7690
Mailing Address - Fax:310-360-9613
Practice Address - Street 1:8484 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3227
Practice Address - Country:US
Practice Address - Phone:310-360-7690
Practice Address - Fax:310-360-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty