# ADVANCED RETINA ASSOCIATES MEDICAL GROUP, INC

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

## Provider details

- **NPI number:** 1730292541
- **Authorized official:** DR. SANJAY LOGANI M.D. (PRESIDENT)
- **Authorized official phone:** (818) 886-6700

## Contact information

- **Practice address:** 17750 SHERMAN WAY, SUITE 100, RESEDA, CA 91335
- **Practice address phone:** (818) 886-6700
- **Practice address fax:** (818) 886-6709
- **Mailing address:** 17750 SHERMAN WAY, SUITE 100, RESEDA, CA 91335
- **Mailing address phone:** (818) 886-6700
- **Mailing address fax:** (818) 886-6709

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPT015370TLG | CA | — |
| 207W00000X | Ophthalmology Physician | G73456 | CA | Yes |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 11/13/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0102220 | — | CA |
| 05 | — | GR0102221 | — | CA |
| 05 | — | GR0102222 | — | CA |
| 05 | — | GR0102223 | — | CA |