Provider Demographics
NPI:1710971742
Name:SEMEL VISION CARE
Entity Type:Organization
Organization Name:SEMEL VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:SEMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-641-1700
Mailing Address - Street 1:390 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4475
Mailing Address - Country:US
Mailing Address - Phone:310-641-1700
Mailing Address - Fax:310-535-2155
Practice Address - Street 1:390 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4475
Practice Address - Country:US
Practice Address - Phone:310-641-1700
Practice Address - Fax:310-535-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G606630Medicaid
CA00G606630Medicaid