Provider Demographics
NPI:1639656432
Name:ANGELA B. NAHL, M.D., INC.
Entity Type:Organization
Organization Name:ANGELA B. NAHL, M.D., INC.
Other - Org Name:LA JOLLA LASIK INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-551-4100
Mailing Address - Street 1:9834 GENESEE AVE.
Mailing Address - Street 2:#428
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1264
Mailing Address - Country:US
Mailing Address - Phone:858-551-4100
Mailing Address - Fax:858-777-5760
Practice Address - Street 1:9834 GENESEE AVE STE 428
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1264
Practice Address - Country:US
Practice Address - Phone:858-551-4100
Practice Address - Fax:858-777-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65284207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty