MEDICARE: LARCHMONT OPTOMETRICS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12815T	CA
2	152W00000X	Optometrist	9938T	CA

General Provider Information

NPI Number	:	1255511796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARCHMONT OPTOMETRICS, INC

Provider Business Mailing Address
First Line	:	317 N LARCHMONT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3011
Country	:	US
Telephone Number	:	323-465-9682
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 N LARCHMONT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3011
Country	:	US
Telephone Number	:	323-465-9682
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. MARIA L. AUERBACH
Credential	:	O.D.
Telephone Number	:	323-465-9682

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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