| Advanced Retina Associates Medical Group, Inc | |
|
17750 Sherman Way, Suite 100, Reseda, CA 91335 | |
| (818) 886-6700 | |
| (818) 886-6709 |
| Full Name | Advanced Retina Associates Medical Group, Inc |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 17750 Sherman Way, Suite 100, Reseda, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730292541 | NPI | - | NPPES |
| GR0102220 | Medicaid | CA | |
| GR0102223 | Medicaid | CA | |
| GR0102222 | Medicaid | CA | |
| GR0102221 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | OPT015370TLG (California) | Secondary |
| 207W00000X | Ophthalmology | G73456 (California) | Primary |
| Provider Name | Sanjay Logani |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1124131958 PECOS PAC ID: 3779553060 Enrollment ID: I20040726001382 |
| Provider Name | Hardeep Kataria |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1043564362 PECOS PAC ID: 8921223454 Enrollment ID: I20151110002655 |
| Provider Name | Amr M Kouchouk |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1639499718 PECOS PAC ID: 3375769342 Enrollment ID: I20151124002441 |
| Provider Name | Aleksandr Zinovyevich Yelenskiy |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1578981395 PECOS PAC ID: 6901161405 Enrollment ID: I20180605000689 |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Retina Associates Medical Group, Inc 17750 Sherman Way, Suite 100, Reseda, CA 91335 Ph: (818) 886-6700 | Advanced Retina Associates Medical Group, Inc 17750 Sherman Way, Suite 100, Reseda, CA 91335 Ph: (818) 886-6700 |