Provider Demographics
NPI:1427186444
Name:DESERT VISION CENTER MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:DESERT VISION CENTER MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-340-4700
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:W105
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-340-4700
Mailing Address - Fax:760-568-2490
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:W105
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-340-4700
Practice Address - Fax:760-568-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG310350207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G310352OtherPTAN
1982629341Medicare NSC
CAZZZ28173ZMedicare PIN
0833630001Medicare NSC
CA00G310352OtherPTAN
CAA44642Medicare UPIN
1427186444Medicare NSC