Provider Demographics
NPI:1356761506
Name:CALIFORNIA CENTER FOR REFRACTIVE SURGERY
Entity type:Organization
Organization Name:CALIFORNIA CENTER FOR REFRACTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-933-3111
Mailing Address - Street 1:4160 WILSHIRE BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3567
Mailing Address - Country:US
Mailing Address - Phone:323-933-3111
Mailing Address - Fax:323-933-3393
Practice Address - Street 1:4160 WILSHIRE BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3567
Practice Address - Country:US
Practice Address - Phone:323-933-3111
Practice Address - Fax:323-933-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15209Medicaid
CAG51341Medicare UPIN