Provider Demographics
NPI:1508130741
Name:LECC GENERAL OPHTHALMOLOGY MANAGEMENT
Entity Type:Organization
Organization Name:LECC GENERAL OPHTHALMOLOGY MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PIRNAZAR MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-951-1457
Mailing Address - Street 1:3501 JAMBOREE RD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2939
Mailing Address - Country:US
Mailing Address - Phone:949-854-7400
Mailing Address - Fax:949-768-8902
Practice Address - Street 1:24022 CALLE DE LA PLATA
Practice Address - Street 2:SUITE 300
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3629
Practice Address - Country:US
Practice Address - Phone:949-951-1457
Practice Address - Fax:949-768-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72632207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty