Healthcare Provider Details

I. General information

NPI: 1659387462
Provider Name (Legal Business Name): STANTON OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9186 W PICO BLVD
LOS ANGELES CA
90035
US

IV. Provider business mailing address

9186 W PICO BLVD
LOS ANGELES CA
90035
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-1702
  • Fax: 310-276-9715
Mailing address:
  • Phone: 310-276-1702
  • Fax: 310-276-9715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD1157
License Number StateCA

VIII. Authorized Official

Name: WALTER HOSKIN
Title or Position: MANAGER
Credential:
Phone: 310-276-1702