Provider Demographics
NPI:1942880349
Name:JACOB REZNIK MD AND ALENA REZNIK MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JACOB REZNIK MD AND ALENA REZNIK MD A PROFESSIONAL CORPORATION
Other - Org Name:GLAUCOMA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:REZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-980-6038
Mailing Address - Street 1:1401 AVOCADO AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7787
Mailing Address - Country:US
Mailing Address - Phone:310-980-6038
Mailing Address - Fax:949-335-6512
Practice Address - Street 1:1401 AVOCADO AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7787
Practice Address - Country:US
Practice Address - Phone:310-980-6038
Practice Address - Fax:949-335-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty