Provider Demographics
NPI:1760689624
Name:CULVER CITY EYE INSTITUTE, INC.
Entity Type:Organization
Organization Name:CULVER CITY EYE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KYOO-HAE
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-838-3834
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2751
Mailing Address - Country:US
Mailing Address - Phone:310-838-3834
Mailing Address - Fax:310-838-8031
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-838-3834
Practice Address - Fax:310-838-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13049152W00000X
CAG39062207W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G390620Medicaid
CAA92045Medicare UPIN
CAG39062Medicare ID - Type Unspecified