Provider Demographics
NPI:1518127281
Name:GLAUCOMA INSTITUTE OF BEVERLY HILLS
Entity Type:Organization
Organization Name:GLAUCOMA INSTITUTE OF BEVERLY HILLS
Other - Org Name:GLAUCOMA INSTITUTE BEVERLY HILLS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-855-1112
Mailing Address - Street 1:8733 BEVERLY BOULEVARD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1800
Mailing Address - Country:US
Mailing Address - Phone:310-855-1112
Mailing Address - Fax:310-855-1211
Practice Address - Street 1:8733 BEVERLY BOULEVARD
Practice Address - Street 2:SUITE 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1800
Practice Address - Country:US
Practice Address - Phone:310-855-1112
Practice Address - Fax:310-855-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31961AMedicare PIN