Provider Demographics
NPI:1346356987
Name:MAGNOLIA EYE CARE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:MAGNOLIA EYE CARE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-894-4599
Mailing Address - Street 1:14571 MAGNOLIA ST
Mailing Address - Street 2:#205
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5574
Mailing Address - Country:US
Mailing Address - Phone:714-894-4599
Mailing Address - Fax:714-897-7367
Practice Address - Street 1:14571 MAGNOLIA ST
Practice Address - Street 2:#205
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5574
Practice Address - Country:US
Practice Address - Phone:714-894-4599
Practice Address - Fax:714-897-7367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A52350Medicare UPIN
A52350Medicare UPIN