Basic Information
| Provider Information | |||||||||
| NPI: | 1881011567 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JULES STEIN EYE INSTITUTE MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108253090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 STEIN PLZ | ||||||||
| Address2: | SUITE 1-188 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108253090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2014 | ||||||||
| LastUpdateDate: | 09/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | MONDINO | ||||||||
| AuthorizedOfficialFirstName: | BARTLY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/CHAIR | ||||||||
| AuthorizedOfficialTelephone: | 3102067202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | CA | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.