Basic Information
| Provider Information | |||||||||
| NPI: | 1659511251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KERRY K ASSIL, MD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 N ROXBURY DR | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902104231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104538911 | ||||||||
| FaxNumber: | 3104532519 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 SANTA MONICA BLVD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104538911 | ||||||||
| FaxNumber: | 3104532519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2009 | ||||||||
| LastUpdateDate: | 02/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | ASSIL | ||||||||
| AuthorizedOfficialFirstName: | KERRY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3104538911 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 152W00000X | G62647 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.