Provider Demographics
NPI:1891892071
Name:PARADIGM VISION CARE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PARADIGM VISION CARE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:BENTON
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-673-2020
Mailing Address - Street 1:301 N PRAIRIE AVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4507
Mailing Address - Country:US
Mailing Address - Phone:310-673-2020
Mailing Address - Fax:
Practice Address - Street 1:301 N PRAIRIE AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4507
Practice Address - Country:US
Practice Address - Phone:310-673-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty