Provider Demographics
NPI:1558510834
Name:DARIN EYE CENTER A MEDICAL
Entity Type:Organization
Organization Name:DARIN EYE CENTER A MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-275-0009
Mailing Address - Street 1:696 HAMPSHIRE ROAD SUITE 120
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-778-1034
Mailing Address - Fax:805-778-9194
Practice Address - Street 1:696 HAMPSHIRE RD STE 120
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4457
Practice Address - Country:US
Practice Address - Phone:818-787-2020
Practice Address - Fax:818-787-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW20551152W00000X
CAG044103332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20551OtherMEDICARE GROUP NUMBER
CA6042720001Medicare NSC