Basic Information
| Provider Information | |||||||||
| NPI: | 1285658633 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOHENY EYE MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 SAN PABLO ST STE 3700 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900334500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234427152 | ||||||||
| FaxNumber: | 3234427166 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 W DUARTE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910079266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264462122 | ||||||||
| FaxNumber: | 3234427166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIR PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3234426425 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 261Q00000X | X | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.