Provider Demographics
NPI:1306066089
Name:DR. JOSEPH'S EYE MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:DR. JOSEPH'S EYE MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHAGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-663-3333
Mailing Address - Street 1:1211 N VERMONT AVE
Mailing Address - Street 2:# 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1748
Mailing Address - Country:US
Mailing Address - Phone:323-663-3333
Mailing Address - Fax:323-661-1197
Practice Address - Street 1:1211 N VERMONT AVE
Practice Address - Street 2:# 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1748
Practice Address - Country:US
Practice Address - Phone:323-663-3333
Practice Address - Fax:323-661-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38640207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G386400Medicaid
CA00G386400Medicaid
CA0185110001Medicare NSC
CAW9928Medicare PIN