Provider Demographics
NPI:1669702288
Name:WOLSTAN & GOLDBERG EYE ASSOCIATES INC., A MEDICAL CORPORATON
Entity type:Organization
Organization Name:WOLSTAN & GOLDBERG EYE ASSOCIATES INC., A MEDICAL CORPORATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WOLSTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-543-2611
Mailing Address - Street 1:23600 TELO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:310-543-2611
Mailing Address - Fax:310-543-2056
Practice Address - Street 1:23600 TELO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4035
Practice Address - Country:US
Practice Address - Phone:310-543-2611
Practice Address - Fax:310-543-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0896110001Medicare NSC