Provider Demographics
NPI:1265698419
Name:BRIAN S. BOXER WACHLER INC, A MEDICAL CORP
Entity type:Organization
Organization Name:BRIAN S. BOXER WACHLER INC, A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOXER WACHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-860-1900
Mailing Address - Street 1:PO BOX 3039
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90408-3039
Mailing Address - Country:US
Mailing Address - Phone:310-860-1900
Mailing Address - Fax:
Practice Address - Street 1:465 N ROXBURY DR STE 902
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4212
Practice Address - Country:US
Practice Address - Phone:310-860-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84557207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16835Medicare PIN