Basic Information
| Provider Information | |||||||||
| NPI: | 1750342622 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATARACT AND CORNEA SURGICAL INSTITUTE, INC | ||||||||
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| OtherOrganizationName: | SOUTHERN CALIFORNIA EYECARE, INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 W WHITTIER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906313893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626942500 | ||||||||
| FaxNumber: | 5626942577 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 W WHITTIER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906313893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626942500 | ||||||||
| FaxNumber: | 5626942577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 01/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | DUDEJA | ||||||||
| AuthorizedOfficialFirstName: | DEEP | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5626942500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | G83764 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.