Provider Demographics
NPI:1336143148
Name:MARIN OPHTHALMIC SURGERY CENTER
Entity Type:Organization
Organization Name:MARIN OPHTHALMIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAFIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNAOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-454-5565
Mailing Address - Street 1:901 E ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-454-5565
Mailing Address - Fax:415-454-6542
Practice Address - Street 1:901 E ST SUITE 270
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-454-5565
Practice Address - Fax:415-454-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000410261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01276FMedicaid
CA=========OtherTAX ID