Provider Demographics
NPI:1457548992
Name:LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP
Entity Type:Organization
Organization Name:LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP
Other - Org Name:LOS ALAMITOS EYE PHYSICIANS & SURGEONS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING/CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-531-2727
Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-531-2020
Mailing Address - Fax:562-531-1142
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-598-7728
Practice Address - Fax:562-598-4209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-28
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW4037AMedicare PIN
CA0822160003Medicare NSC