MEDICARE: GLASS HOUSE OPTOMETRY 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	OPT 13026TPL	CA

General Provider Information

NPI Number	:	1518241983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLASS HOUSE OPTOMETRY INC

Provider Business Mailing Address
First Line	:	4203 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-2922
Country	:	US
Telephone Number	:	562-433-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4203 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-2922
Country	:	US
Telephone Number	:	562-433-1700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SINAVY SAO
Credential	:	O.D.
Telephone Number	:	562-433-1700

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	10/14/2016

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Directions to “GLASS HOUSE OPTOMETRY INC ” Practice Location

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