Provider Demographics
NPI:1396913315
Name:CARSON MC BEATH & BOSWELL INC
Entity type:Organization
Organization Name:CARSON MC BEATH & BOSWELL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-984-7024
Mailing Address - Street 1:4300 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2011
Mailing Address - Country:US
Mailing Address - Phone:562-984-7024
Mailing Address - Fax:562-984-9477
Practice Address - Street 1:7677 CENTER AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3074
Practice Address - Country:US
Practice Address - Phone:714-657-7809
Practice Address - Fax:714-657-7811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARSON MC BEATH & BOSWELL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-12
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6562CMedicare PIN