| La Sight Medical Center A Prof Corp | |
|
11600 Wilshire Blvd. Suite 200 Los Angeles CA 90025-1782 | |
| (310) 828-2020 | |
| (310) 914-3009 |
| Full Name | La Sight Medical Center A Prof Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 11600 Wilshire Blvd., Los Angeles, California |
| Authorized Official Name and Position | David Alan Wallace (PRESIDENT) |
| Authorized Official Contact | 3108282020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Sight Medical Center A Prof Corp 11600 Wilshire Blvd. Suite 200 Los Angeles CA 90025-1782 Ph: (310) 828-2020 | La Sight Medical Center A Prof Corp 11600 Wilshire Blvd. Suite 200 Los Angeles CA 90025-1782 Ph: (310) 828-2020 |
| NPI Number | 1700105491 |
|---|---|
| Provider Enumeration Date | 05/20/2010 |
| Last Update Date | 05/20/2010 |
| Medicare PECOS PAC ID | 4880718519 |
|---|---|
| Medicare Enrollment ID | O20100908000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700105491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Sima Tabanfar |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1528236502 PECOS PAC ID: 7810978756 Enrollment ID: I20040526001699 |
| Provider Name | Uday Devgan |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1801831219 PECOS PAC ID: 3870556442 Enrollment ID: I20041105000197 |
| Provider Name | David A Wallace |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1679576276 PECOS PAC ID: 9436273257 Enrollment ID: I20100901000402 |
| Provider Name | Majid R Moarefi |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1275890246 PECOS PAC ID: 4880998194 Enrollment ID: I20180914000914 |
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