Healthcare Provider Details

I. General information

NPI: 1649224049
Provider Name (Legal Business Name): MORE VISION EYE CARE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5181 HOLLYWOOD BLVD
LOS ANGELES CA
90027-6113
US

IV. Provider business mailing address

5181 HOLLYWOOD BLVD
LOS ANGELES CA
90027-6113
US

V. Phone/Fax

Practice location:
  • Phone: 323-662-9629
  • Fax: 323-662-0915
Mailing address:
  • Phone: 323-662-9629
  • Fax: 323-662-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberA20843
License Number StateCA

VIII. Authorized Official

Name: MR. RICHARD MICHAEL TELLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-662-9629