Provider Demographics
NPI:1184809246
Name:EYE INSTITUTE OF LOS ANGELES
Entity type:Organization
Organization Name:EYE INSTITUTE OF LOS ANGELES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIN CHEU
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-572-3937
Mailing Address - Street 1:420 N GARFIELD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1206
Mailing Address - Country:US
Mailing Address - Phone:626-572-3937
Mailing Address - Fax:626-571-8847
Practice Address - Street 1:420 N GARFIELD AVE STE 208
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1206
Practice Address - Country:US
Practice Address - Phone:626-572-3937
Practice Address - Fax:626-571-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56514207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G565140Medicaid
CA00G565140Medicaid
CAW11121Medicare PIN