Provider Demographics
NPI:1548351943
Name:NIKOU EYE SURGICAL & MEDICAL CENTER INC.
Entity type:Organization
Organization Name:NIKOU EYE SURGICAL & MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:NIKOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-240-2241
Mailing Address - Street 1:222 W EULALIA ST STE 315
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2852
Mailing Address - Country:US
Mailing Address - Phone:818-240-2242
Mailing Address - Fax:818-240-2232
Practice Address - Street 1:222 W EULALIA ST STE 315
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2852
Practice Address - Country:US
Practice Address - Phone:818-240-2242
Practice Address - Fax:818-240-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19201Medicare PIN