Organization
GLENDALE OPHTHALMOLOGY ASC LP
Active
Other names
Glendale Eye Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP A CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
607 N CENTRAL AVE, SUITE 103, GLENDALE, CA 91203-1804
(818) 956-1010
(818) 543-6083
Mailing address
607 N CENTRAL AVE, SUITE 103, GLENDALE, CA 91203-1804
(818) 956-1010
(818) 543-6083
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
930000717
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05-C0001131
—
CA
Enumeration date
02/08/2006
Last updated
09/07/2023
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