Provider Demographics
NPI:1740688654
Name:IRA VIDOR, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:IRA VIDOR, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-689-8786
Mailing Address - Street 1:366 SAN MIGUEL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7810
Mailing Address - Country:US
Mailing Address - Phone:949-999-8717
Mailing Address - Fax:949-315-3449
Practice Address - Street 1:366 SAN MIGUEL DR STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-999-8717
Practice Address - Fax:949-315-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108065207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty