Basic Information
| Provider Information | |||||||||
| NPI: | 1326006966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JULES STEIN EYE INSTITUTE MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 2939 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900742939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103018750 | ||||||||
| FaxNumber: | 3103018751 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 STEIN PLZ | ||||||||
| Address2: | RM-1340 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900957065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108253090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | HALE | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF ACCOUNTING | ||||||||
| AuthorizedOfficialTelephone: | 3103015311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | GR0058400 | 05 | CA | MEDICAID | GSD003170 | 05 | CA | MEDICAID |