Healthcare Provider Details

I. General information

NPI: 1588469167
Provider Name (Legal Business Name): OPTICA OPTOMETRY VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 PARAMOUNT BLVD UNIT B
PARAMOUNT CA
90723-5425
US

IV. Provider business mailing address

16259 PARAMOUNT BLVD UNIT B
PARAMOUNT CA
90723-5425
US

V. Phone/Fax

Practice location:
  • Phone: 424-529-6645
  • Fax:
Mailing address:
  • Phone: 424-529-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TARIQ TAHIR KHRAISHI
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 310-864-9323