Provider Demographics
NPI:1730365446
Name:EAST-WEST EYE INSTITUTE A MEDICAL CORPORATION
Entity type:Organization
Organization Name:EAST-WEST EYE INSTITUTE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-688-6205
Mailing Address - Street 1:420 E 3RD ST
Mailing Address - Street 2:STE 603
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1645
Mailing Address - Country:US
Mailing Address - Phone:213-625-2694
Mailing Address - Fax:213-680-9299
Practice Address - Street 1:1950 SAWTELLE BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7014
Practice Address - Country:US
Practice Address - Phone:310-453-0489
Practice Address - Fax:310-453-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
CA1176620002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078583Medicaid
CA1176620002Medicare NSC
CAW13961BMedicare PIN