Provider Demographics
NPI:1629274337
Name:CENTURY EYE CARE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:CENTURY EYE CARE MEDICAL CENTER, INC.
Other - Org Name:CENTURY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-767-7814
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-767-7814
Mailing Address - Fax:310-323-3785
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:STE 101
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:310-644-8877
Practice Address - Fax:310-644-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83156207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G831561Medicaid
CA00G831561Medicaid
CAW17217BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
CA1249690002Medicare NSC