Provider Demographics
NPI:1518132596
Name:OCULAR INSTITUTE OF CALIFORNIA, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:OCULAR INSTITUTE OF CALIFORNIA, A MEDICAL CORPORATION
Other - Org Name:LASERPRO EYE LASER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SHUOH-TYNG
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-485-4007
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-0708
Mailing Address - Country:US
Mailing Address - Phone:626-485-4007
Mailing Address - Fax:
Practice Address - Street 1:17833 COLIMA RD
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1729
Practice Address - Country:US
Practice Address - Phone:626-964-8864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52809Medicare UPIN
CAW15680AMedicare PIN