Provider Demographics
NPI:1437203635
Name:ALLIANCE EYE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ALLIANCE EYE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:323-263-6774
Mailing Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 6500
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2585
Mailing Address - Country:US
Mailing Address - Phone:323-263-6774
Mailing Address - Fax:323-263-1277
Practice Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 6500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2585
Practice Address - Country:US
Practice Address - Phone:323-263-6774
Practice Address - Fax:323-263-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067530Medicaid
CA0399880001Medicare NSC
CAW13569Medicare ID - Type Unspecified
CA180023785Medicare PIN