Provider Demographics
NPI:1770865735
Name:VISION INSTITUTE OF SOUTHERN CALIFORNIA A PROFESSIONAL MEDICAL CORPORA
Entity Type:Organization
Organization Name:VISION INSTITUTE OF SOUTHERN CALIFORNIA A PROFESSIONAL MEDICAL CORPORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TING-CHAY
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-854-2020
Mailing Address - Street 1:18725 GALE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1358
Mailing Address - Country:US
Mailing Address - Phone:626-854-2020
Mailing Address - Fax:626-854-2021
Practice Address - Street 1:18725 GALE AVE STE 140
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1358
Practice Address - Country:US
Practice Address - Phone:626-854-2020
Practice Address - Fax:626-854-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A559520Medicaid
CAA55952AMedicare PIN
CA00A559520Medicaid
CAG70428Medicare UPIN