Provider Demographics
NPI:1376163337
Name:ADVANCED EYE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ADVANCED EYE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-886-6700
Mailing Address - Street 1:17750 SHERMAN WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-8331
Mailing Address - Country:US
Mailing Address - Phone:818-886-6700
Mailing Address - Fax:818-886-6709
Practice Address - Street 1:17750 SHERMAN WAY STE 100
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-8331
Practice Address - Country:US
Practice Address - Phone:818-886-6700
Practice Address - Fax:818-886-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery