Healthcare Provider Details

I. General information

NPI: 1083905558
Provider Name (Legal Business Name): MELAMED EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8213 BEVERLY BLVD
LOS ANGELES CA
90048-4505
US

IV. Provider business mailing address

8213 BEVERLY BLVD
LOS ANGELES CA
90048-4505
US

V. Phone/Fax

Practice location:
  • Phone: 323-655-6582
  • Fax: 323-655-6473
Mailing address:
  • Phone: 323-655-6582
  • Fax: 323-655-6473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: FOUAD MELAMED
Title or Position: PRESIDENT
Credential: O.D.
Phone: 323-655-6582