Evergreen Retina Inc a Professional Medical Corporation

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

Legal business name

EVERGREEN RETINA INC A PROFESSIONAL MEDICAL CORPORATION

Practice address

27335 Tourney Rd Ste 210
Valencia, CA 91355-2205

Phone

(661) 455-7797

NPI assigned

Feb 28, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Julia Sein, MDNPI 1295178291

Title

Owner

Phone

(661) 455-7797

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: jsein@ersc.intellechartdirect.net

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julia Sein, MD

  • Retina Specialist (Ophthalmology) Physician
  • Valencia, CA
  • NPI 1295178291
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1942067723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27335 TOURNEY RD STE 210",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913552205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27335 TOURNEY RD STE 210",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913552205",
            "telephone_number": "661-455-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN RETINA INC A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-28",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "SEIN",
        "authorized_official_first_name": "JULIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "661-455-7797",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Retina Specialist (Ophthalmology) Physician in Valencia, CA
• Providers in Valencia, CA by specialty
• Retina Specialist (Ophthalmology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.