Organization
ADVANCED RETINA ASSOCIATES MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANJAY LOGANI M.D. (PRESIDENT)
(818) 886-6700
Entity
Organization
Contact information
Practice address
17750 SHERMAN WAY, SUITE 100, RESEDA, CA 91335
(818) 886-6700
(818) 886-6709
Mailing address
17750 SHERMAN WAY, SUITE 100, RESEDA, CA 91335
(818) 886-6700
(818) 886-6709
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPT015370TLG
CA
207W00000X
Ophthalmology Physician
Primary
G73456
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0102220
—
CA
05
—
GR0102221
—
CA
05
—
GR0102222
—
CA
05
—
GR0102223
—
CA
Enumeration date
08/16/2006
Last updated
11/13/2017
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