# EYE CARE FOR DIABETICS MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eye Care for Diabetics Medical Group, Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083813380
- **Authorized official:** LEROY W VAUGHN MD (OPHTHALMOLOGIST)
- **Authorized official phone:** (310) 671-0909

## Contact information

- **Practice address:** 323 N PRAIRIE AVE, 217, INGLEWOOD, CA 90301-4502
- **Practice address phone:** (310) 671-0909
- **Practice address fax:** (310) 412-0066
- **Mailing address:** 323 N PRAIRIE AVE, 217, INGLEWOOD, CA 90301-4502
- **Mailing address phone:** (310) 671-0909
- **Mailing address fax:** (310) 412-0066

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/16/2007
- **Last updated:** 06/04/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | A00305761 | — | CA |