Healthcare Provider Details

I. General information

NPI: 1396259669
Provider Name (Legal Business Name): EYE PEOPLE OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2156 MONTEBELLO TOWN CTR
MONTEBELLO CA
90640-2170
US

IV. Provider business mailing address

2156 MONTEBELLO TOWN CTR
MONTEBELLO CA
90640-2170
US

V. Phone/Fax

Practice location:
  • Phone: 323-720-1600
  • Fax:
Mailing address:
  • Phone: 323-720-1600
  • Fax: 323-278-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15317TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number15317TLG
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number15317TLG
License Number StateCA

VIII. Authorized Official

Name: JENNIFER KHEM
Title or Position: CEO
Credential: OD
Phone: 424-346-2845