# DE LA PENA EYE CLINIC, A MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114931052
- **Authorized official:** MARK KELLY (MEMBER, BOARD OF MANAGERS)
- **Authorized official phone:** (615) 345-6900

## Contact information

- **Practice address:** 2446 W WHITTIER BLVD, MONTEBELLO, CA 90640-3041
- **Practice address phone:** (323) 728-5500
- **Practice address fax:** (323) 728-4408
- **Mailing address:** 401 COMMERCE ST STE 600, NASHVILLE, TN 37219-2518
- **Mailing address phone:** (615) 345-6900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 08/12/2022