Provider Demographics
NPI:1720184666
Name:PAUL B DONZIS MD INC
Entity Type:Organization
Organization Name:PAUL B DONZIS MD INC
Other - Org Name:EYE INSTITUTE OF MARINA DEL REY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DONZIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-822-0022
Mailing Address - Street 1:4644 LINCOLN BLVD
Mailing Address - Street 2:#102
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6374
Mailing Address - Country:US
Mailing Address - Phone:310-822-0022
Mailing Address - Fax:310-822-9636
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:#102
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6374
Practice Address - Country:US
Practice Address - Phone:310-822-0022
Practice Address - Fax:310-822-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42774207W00000X
CAA71125207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W15415Medicare ID - Type Unspecified