Provider Demographics
NPI:1750501383
Name:OCULAR SURGERY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:OCULAR SURGERY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-303-7788
Mailing Address - Street 1:931 BUENA VISTA ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1712
Mailing Address - Country:US
Mailing Address - Phone:626-303-7788
Mailing Address - Fax:626-359-8912
Practice Address - Street 1:931 BUENA VISTA ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1712
Practice Address - Country:US
Practice Address - Phone:626-303-7788
Practice Address - Fax:626-359-8912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0077480Medicaid
CAGR0077480Medicaid