Organization
LYDIA MATKOVICH, M.D. A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYDIA MATKOVICH M.D. (OWNER)
(310) 626-8055
Entity
Organization
Contact information
Practice address
23600 TELO AVE, SUITE 210, TORRANCE, CA 90505-4035
(310) 626-8055
(310) 626-8058
Mailing address
23600 TELO AVE, SUITE 210, TORRANCE, CA 90505-4035
(310) 626-8055
(310) 626-8058
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G80774
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006807740
BLUE SHIELD
CA
05
—
00G807740
—
CA
05
—
00G807741
—
CA
01
—
P00286193
RAILROAD MEDICARE
CA
Enumeration date
06/18/2006
Last updated
03/05/2008
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