Provider Demographics
NPI:1336241199
Name:EMERALD EYE CENTER INC
Entity Type:Organization
Organization Name:EMERALD EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-937-7679
Mailing Address - Street 1:16260 VENTURA BLVD
Mailing Address - Street 2:SUITE711
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2203
Mailing Address - Country:US
Mailing Address - Phone:323-316-8186
Mailing Address - Fax:818-784-7000
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE711
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:323-316-8186
Practice Address - Fax:818-784-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM920OtherMEDICARE PTAN