# GLENDALE RETINA ASSOCIATES MEDICAL GROUP INC.

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

## Provider details

- **NPI number:** 1609989425
- **Authorized official:** SANJAY LOGANI MD (PRESIDENT)
- **Authorized official phone:** (818) 886-6700

## Contact information

- **Practice address:** 1025 N BRAND BLVD, SUITE 200, GLENDALE, CA 91202-2950
- **Practice address phone:** (818) 230-2140
- **Practice address fax:** (818) 230-2148
- **Mailing address:** 1025 N BRAND BLVD, SUITE 200, GLENDALE, CA 91202-2950
- **Mailing address phone:** (818) 230-2140
- **Mailing address fax:** (818) 230-2148

## Taxonomy

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

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 09/21/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0104990 | — | CA |