| |
3816 Woodruff Ave Ste 100, Long Beach, CA 90808-2145 | |
(562) 424-0931 | |
(562) 492-9400 |
Full Name | |
---|---|
Type | Facility |
Speciality | Specialist |
Location | 3816 Woodruff Ave Ste 100, Long Beach, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1801267513 | NPI | - | NPPES |
1114205432 | Medicaid | CA | |
FQ161A | Other | CA | MCR(S) |
FQ161B | Other | CA | MCR(N) |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
174400000X | Specialist | (* (Not Available)) | Primary |
207W00000X | Ophthalmology | (California) | Secondary |
Mailing Address | Practice Location Address |
---|---|
100 E California Blvd, Pasadena, CA 91105-3205 Ph: (626) 568-8868 | 3816 Woodruff Ave Ste 100, Long Beach, CA 90808-2145 Ph: (562) 424-0931 |