Provider Demographics
NPI:1437298759
Name:IRA E OPATOWSKY MD INC
Entity Type:Organization
Organization Name:IRA E OPATOWSKY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-948-4373
Mailing Address - Street 1:42543 8TH ST W
Mailing Address - Street 2:STE 101
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7200
Mailing Address - Country:US
Mailing Address - Phone:661-948-4373
Mailing Address - Fax:661-948-6216
Practice Address - Street 1:42543 8TH ST W
Practice Address - Street 2:STE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7200
Practice Address - Country:US
Practice Address - Phone:661-948-4373
Practice Address - Fax:661-948-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1268970001Medicare NSC