Healthcare Provider Details

I. General information

NPI: 1104346642
Provider Name (Legal Business Name): OPTOMETRIC ODYSSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 COLORADO AVE STE E
SANTA MONICA CA
90404-3589
US

IV. Provider business mailing address

2200 COLORADO AVE STE E
SANTA MONICA CA
90404-3589
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-6232
  • Fax: 310-828-5352
Mailing address:
  • Phone: 310-828-6232
  • Fax: 310-828-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD FERRO
Title or Position: OPTOMETRIST
Credential: OD
Phone: 310-828-6262