Healthcare Provider Details

I. General information

NPI: 1417090606
Provider Name (Legal Business Name): OLYMPIC OPTOMETRIC CENTER, INC., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16444 PARAMOUNT BLVD SUITE 206
PARAMOUNT CA
90723-5422
US

IV. Provider business mailing address

16444 PARAMOUNT BLVD. STE. 206
PARAMOUNT CA
90723-5454
US

V. Phone/Fax

Practice location:
  • Phone: 323-732-8111
  • Fax: 323-638-2934
Mailing address:
  • Phone: 323-732-8111
  • Fax: 323-638-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LORIE J. KOOK
Title or Position: PRESIDENT
Credential: O.D.
Phone: 323-732-8111