Healthcare Provider Details

I. General information

NPI: 1699095315
Provider Name (Legal Business Name): EYE CARE CENTER ANI HALABI OD DOCTOR OF OPTOMETRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E GLENOAKS BLVD SUITE #B
GLENDALE CA
91207-2013
US

IV. Provider business mailing address

413 E GLENOAKS BLVD # B
GLENDALE CA
91207-2013
US

V. Phone/Fax

Practice location:
  • Phone: 818-230-0550
  • Fax: 818-244-8175
Mailing address:
  • Phone: 818-489-8537
  • Fax: 818-244-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number12807
License Number StateCA

VIII. Authorized Official

Name: DR. ANI HALABI
Title or Position: OWNER
Credential: O.D.
Phone: 818-230-0550