Provider Demographics
NPI:1609948371
Name:MERCY EYE CARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MERCY EYE CARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-526-7273
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2469
Mailing Address - Country:US
Mailing Address - Phone:323-526-7273
Mailing Address - Fax:323-526-7235
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2469
Practice Address - Country:US
Practice Address - Phone:323-526-7273
Practice Address - Fax:323-526-7235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48969207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489690Medicaid
CAG77360Medicare UPIN
CAW15310Medicare ID - Type Unspecified