Provider Demographics
NPI:1740357698
Name:ANDREW BALFOUR & ROBERT SHAPIRO
Entity type:Organization
Organization Name:ANDREW BALFOUR & ROBERT SHAPIRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:213-627-5911
Mailing Address - Street 1:555 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-2301
Mailing Address - Country:US
Mailing Address - Phone:213-627-5911
Mailing Address - Fax:213-622-8048
Practice Address - Street 1:555 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2301
Practice Address - Country:US
Practice Address - Phone:213-627-5911
Practice Address - Fax:213-622-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000430Medicaid
CA0343080001Medicare NSC
CAWY4855Medicare ID - Type UnspecifiedNHIC GROUP NUMBER