Provider Demographics
NPI:1154543387
Name:BEVERLY HILLS EYE MEDICAL GROUP, INC
Entity type:Organization
Organization Name:BEVERLY HILLS EYE MEDICAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SALZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-360-0609
Mailing Address - Street 1:240 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3324
Mailing Address - Country:US
Mailing Address - Phone:310-360-0609
Mailing Address - Fax:310-360-0119
Practice Address - Street 1:240 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3324
Practice Address - Country:US
Practice Address - Phone:310-360-0609
Practice Address - Fax:310-360-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15140OtherMEDICARE GROUP NUMBER
CAU71946Medicare UPIN
CAA38639Medicare UPIN