# A CENTER FOR VISIONCARE SURGICAL & MEDICAL GROUP

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

## Provider details

- **NPI number:** 1912058728
- **Authorized official:** DR. DANA I TANNENBAUM M.D. (MANAGING PARTNER)
- **Authorized official phone:** (818) 762-0647

## Contact information

- **Practice address:** 2031 W ALAMEDA AVE STE 300, BURBANK, CA 91506-2960
- **Practice address phone:** (818) 762-0647
- **Practice address fax:** (818) 762-7834
- **Mailing address:** 4418 VINELAND AVE, 106, NORTH HOLLYWOOD, CA 91602-3457
- **Mailing address phone:** (818) 762-0647
- **Mailing address fax:** (818) 762-7834

## Taxonomy

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

## Other

- **Enumeration date:** 01/16/2007
- **Last updated:** 03/15/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0059240 | — | CA |
| 05 | — | GSD001470 | — | CA |
| 01 | — | ZZZ39782Z | BLUE SHIELD | CA |