Provider Demographics
NPI:1013105048
Name:EYE CARE FIRST , A MEDICAL GROUP,INC.
Entity Type:Organization
Organization Name:EYE CARE FIRST , A MEDICAL GROUP,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:TALEBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-507-0055
Mailing Address - Street 1:610 N CENTRAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1419
Mailing Address - Country:US
Mailing Address - Phone:818-507-0055
Mailing Address - Fax:818-507-0036
Practice Address - Street 1:610 N CENTRAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1419
Practice Address - Country:US
Practice Address - Phone:818-507-0055
Practice Address - Fax:818-507-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52012207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E03997Medicare UPIN