Provider Demographics
NPI:1801272398
Name:EYE INSTITUTE OF SOUTHERN CALIFORNIA, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:EYE INSTITUTE OF SOUTHERN CALIFORNIA, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAFZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-300-7304
Mailing Address - Street 1:16311 VENTURA BLVD STE 955
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4339
Mailing Address - Country:US
Mailing Address - Phone:818-650-2000
Mailing Address - Fax:818-884-0231
Practice Address - Street 1:16311 VENTURA BLVD STE 955
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4339
Practice Address - Country:US
Practice Address - Phone:818-650-2000
Practice Address - Fax:818-884-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120299207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty