# HERTZOG EYE ASSOCIATES A MEDICAL CORPORATION

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

## Provider details

- **NPI number:** 1619165446
- **Authorized official:** DR. LEIF HERTZOG MD (MD)
- **Authorized official phone:** (562) 595-4366

## Contact information

- **Practice address:** 5094 E LOS COYOTES DIAGONAL, LONG BEACH, CA 90815-2839
- **Practice address phone:** (562) 597-3100
- **Practice address fax:** (562) 597-5055
- **Mailing address:** 5094 E LOS COYOTES DIAGONAL, LONG BEACH, CA 90815-2839
- **Mailing address phone:** (562) 597-3100
- **Mailing address fax:** (562) 597-5055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | G52761 | CA | Yes |

## Other

- **Enumeration date:** 10/05/2007
- **Last updated:** 12/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | W15323 | GROUP | CA |