Provider Demographics
NPI:1669874582
Name:CASTER EYE CENTER MEDICAL GROUP
Entity type:Organization
Organization Name:CASTER EYE CENTER MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:I
Authorized Official - Last Name:CASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-1221
Mailing Address - Street 1:9100 WILSHIRE BLVD STE 265E
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3440
Mailing Address - Country:US
Mailing Address - Phone:310-274-1221
Mailing Address - Fax:310-274-0244
Practice Address - Street 1:9100 WILSHIRE BLVD STE 265E
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3440
Practice Address - Country:US
Practice Address - Phone:310-274-1221
Practice Address - Fax:310-274-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50244Medicare UPIN