Organization
EYE CARE FOR DIABETICS MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEROY W VAUGHN SR. MD (PRESIDENT/OWNER)
(310) 671-0909
Entity
Organization
Contact information
Practice address
323 N PRAIRIE AVE, SUITE 217, INGLEWOOD, CA 90301-4502
(310) 671-0909
(310) 412-0066
Mailing address
323 N PRAIRIE AVE, SUITE 217, INGLEWOOD, CA 90301-4502
(310) 671-0909
(310) 412-0066
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
A30576
CA
Other
Enumeration date
12/04/2008
Last updated
12/04/2008
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