Basic Information
| Provider Information | |||||||||
| NPI: | 1023392966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | H SHAMMAS MD INC | ||||||||
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| OtherOrganizationName: | SHAMMAS EYE MEDICAL CENTER DOWNEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3510 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902622010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106389391 | ||||||||
| FaxNumber: | 3106038749 | ||||||||
| Practice Location | |||||||||
| Address1: | 8409 FLORENCE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902403962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106389391 | ||||||||
| FaxNumber: | 3106038749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2011 | ||||||||
| LastUpdateDate: | 10/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | MILKIE | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3106389391 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | H SHAMMAS MD INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | W1243 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.