Healthcare Provider Details

I. General information

NPI: 1477871390
Provider Name (Legal Business Name): VISIONMAX OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19733 RINALDI ST
NORTHRIDGE CA
91326-4143
US

IV. Provider business mailing address

19733 RINALDI ST
NORTHRIDGE CA
91326-4143
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number11143T
License Number StateCA

VIII. Authorized Official

Name: DR. CATHERINE HAN
Title or Position: OWNER
Credential:
Phone: 818-832-4646