Healthcare Provider Details

I. General information

NPI: 1356205652
Provider Name (Legal Business Name): ECS OF LOS ANGELES I OPTOMETRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21612 PLANO TRABUCO RD STE C
TRABUCO CANYON CA
92679-3488
US

IV. Provider business mailing address

111 E 4TH ST ALTON IL 62002 SUITE 440
ALTON IL
62002
US

V. Phone/Fax

Practice location:
  • Phone: 618-462-9818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELISSA ALLISON
Title or Position: SR. DIRECTOR MVC
Credential:
Phone: 618-604-5208