Healthcare Provider Details

I. General information

NPI: 1457705055
Provider Name (Legal Business Name): CHERYL ANN CONOVALOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25825 VERMONT AVE
HARBOR CITY CA
90710-3518
US

IV. Provider business mailing address

25825 VERMONT AVE
HARBOR CITY CA
90710-3518
US

V. Phone/Fax

Practice location:
  • Phone: 424-328-2495
  • Fax:
Mailing address:
  • Phone: 424-328-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: