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Organization
A CENTER FOR VISIONCARE SURGICAL & MEDICAL GROUP
Active
Organization
A CENTER FOR VISIONCARE SURGICAL & MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANA I TANNENBAUM M.D. (MANAGING PARTNER)
(818) 762-0647
Entity
Organization
Contact information
Practice address
2031 W ALAMEDA AVE STE 300, BURBANK, CA 91506-2960
(818) 762-0647
(818) 762-7834
Mailing address
4418 VINELAND AVE, 106, NORTH HOLLYWOOD, CA 91602-3457
(818) 762-0647
(818) 762-7834
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059240
—
CA
05
—
GSD001470
—
CA
01
—
ZZZ39782Z
BLUE SHIELD
CA
Enumeration date
01/16/2007
Last updated
03/15/2022
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