Provider Demographics
NPI:1649211533
Name:DARIN EYE CENTER A MEDICAL
Entity Type:Organization
Organization Name:DARIN EYE CENTER A MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAJACICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-787-2020
Mailing Address - Street 1:696 HAMPSHIRE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2699
Mailing Address - Country:US
Mailing Address - Phone:818-787-2020
Mailing Address - Fax:818-787-8652
Practice Address - Street 1:14914 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2113
Practice Address - Country:US
Practice Address - Phone:818-787-2020
Practice Address - Fax:818-787-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20551Medicare PIN