Provider Demographics
NPI:1942301395
Name:PASADENA EYE MEDICAL GROUP
Entity Type:Organization
Organization Name:PASADENA EYE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-796-5325
Mailing Address - Street 1:10 CONGRESS ST
Mailing Address - Street 2:STE 340
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3023
Mailing Address - Country:US
Mailing Address - Phone:626-796-5325
Mailing Address - Fax:626-796-5325
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:STE 340
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3023
Practice Address - Country:US
Practice Address - Phone:626-796-5325
Practice Address - Fax:626-796-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A243881Medicaid
CA4697820001OtherBOWNS DMERC
CAA24388OtherBOWNS CA LIC
CAZZZ79446ZMedicaid
CAC13148OtherRIFFENBURGH CA LIC
CAF26163OtherYU CA LIC
CAG25807OtherWU CA LIC
CA4697820001OtherBOWNS DMERC
CAF26163Medicare UPIN
CAA30219Medicare UPIN
CAA23958Medicare UPIN
CA1094740001Medicare NSC
CAZZZ79446ZMedicaid
CAF26163Medicare UPIN
CAZZZ79446ZMedicaid
CA1094740001Medicare NSC