Provider Demographics
NPI:1629041157
Name:THE WESTLAKE OPHTHALMOLOGY ASC, LLC
Entity Type:Organization
Organization Name:THE WESTLAKE OPHTHALMOLOGY ASC, LLC
Other - Org Name:WESTLAKE EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-583-3950
Mailing Address - Street 1:75 ENTERPRISE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2626
Mailing Address - Country:US
Mailing Address - Phone:949-688-6205
Mailing Address - Fax:
Practice Address - Street 1:2900 TOWNSGATE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3001
Practice Address - Country:US
Practice Address - Phone:805-496-6789
Practice Address - Fax:805-494-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000450261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS551006AMedicaid
CAS551006AMedicaid