Provider Demographics
NPI:1902971302
Name:BEVERLY HILLS VISION CENTER INC
Entity Type:Organization
Organization Name:BEVERLY HILLS VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KHODABAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-550-7888
Mailing Address - Street 1:450 N BEDFORD DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4324
Mailing Address - Country:US
Mailing Address - Phone:310-550-7888
Mailing Address - Fax:310-550-8999
Practice Address - Street 1:450 N BEDFORD DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4324
Practice Address - Country:US
Practice Address - Phone:310-550-7888
Practice Address - Fax:310-550-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85260261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHI9981Medicare UPIN
A85260Medicare ID - Type Unspecified