Advanced Retina Associates Medical Group, Inc | |
17750 Sherman Way, Suite 100, Reseda, CA 91335 | |
(818) 886-6700 | |
(818) 886-6709 |
Full Name | Advanced Retina Associates Medical Group, Inc |
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Type | Facility |
Speciality | Ophthalmology |
Location | 17750 Sherman Way, Suite 100, Reseda, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1730292541 | NPI | - | NPPES |
GR0102220 | Medicaid | CA | |
GR0102223 | Medicaid | CA | |
GR0102222 | Medicaid | CA | |
GR0102221 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPT015370TLG (California) | Secondary |
207W00000X | Ophthalmology | G73456 (California) | Primary |
Provider Name | Sanjay Logani |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1124131958 PECOS PAC ID: 3779553060 Enrollment ID: I20040726001382 |
Provider Name | Hardeep Kataria |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1043564362 PECOS PAC ID: 8921223454 Enrollment ID: I20151110002655 |
Provider Name | Amr M Kouchouk |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1639499718 PECOS PAC ID: 3375769342 Enrollment ID: I20151124002441 |
Provider Name | Aleksandr Zinovyevich Yelenskiy |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1578981395 PECOS PAC ID: 6901161405 Enrollment ID: I20180605000689 |
Mailing Address | Practice Location Address |
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Advanced Retina Associates Medical Group, Inc 17750 Sherman Way, Suite 100, Reseda, CA 91335 Ph: (818) 886-6700 | Advanced Retina Associates Medical Group, Inc 17750 Sherman Way, Suite 100, Reseda, CA 91335 Ph: (818) 886-6700 |