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Organization
DOHENY EYE MEDICAL GROUP, INC
Active
Organization
DOHENY EYE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD E SMITH M.D. (CHAIRMAN)
(323) 442-6425
Entity
Organization
Contact information
Practice address
40055 BOB HOPE DR, SUITE J, RANCHO MIRAGE, CA 92270-3937
(760) 320-2133
(760) 327-0495
Mailing address
1450 SAN PABLO ST, SUITE 3700, LOS ANGELES, CA 90033-4500
(323) 442-7152
(323) 442-7166
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059892
—
CA
01
—
ZZZ51610Z
BLUE SHIELD
CA
Enumeration date
12/28/2006
Last updated
02/27/2008
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