Provider Demographics
NPI:1356371074
Name:HARVARD EYE ASSOCIATES
Entity type:Organization
Organization Name:HARVARD EYE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:KERSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-951-2020
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3665
Mailing Address - Country:US
Mailing Address - Phone:949-951-2020
Mailing Address - Fax:949-900-5321
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 300
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3665
Practice Address - Country:US
Practice Address - Phone:949-951-2020
Practice Address - Fax:949-900-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0044550Medicaid
CAW3786AMedicare ID - Type Unspecified
CAW3786BMedicare ID - Type Unspecified