Provider Demographics
NPI:1245414960
Name:OPHTHALMOLOGY CORPORATION
Entity type:Organization
Organization Name:OPHTHALMOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGY GLAUCOMA
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-922-2288
Mailing Address - Street 1:PO BOX 3187
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-3187
Mailing Address - Country:US
Mailing Address - Phone:847-922-2288
Mailing Address - Fax:562-427-2525
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:SUITE #330
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1516
Practice Address - Country:US
Practice Address - Phone:562-427-0700
Practice Address - Fax:562-427-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH66378Medicare UPIN