Provider Demographics
NPI:1609155084
Name:IRINA GANELIS, M.D., P.C.
Entity Type:Organization
Organization Name:IRINA GANELIS, M.D., P.C.
Other - Org Name:LOS ANGELES EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:BYKHOVSKAYA
Authorized Official - Last Name:GANELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-773-3396
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 396
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-773-3396
Mailing Address - Fax:
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 523
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-394-0003
Practice Address - Fax:206-350-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty