Healthcare Provider Details

I. General information

NPI: 1053775502
Provider Name (Legal Business Name): ADVANCED ARTIFICIAL EYES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21112 VENTURA BLVD
WOODLAND HILLS CA
91364-2103
US

IV. Provider business mailing address

21112 VENTURA BLVD
WOODLAND HILLS CA
91364-2103
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-1666
  • Fax: 818-758-1786
Mailing address:
  • Phone: 818-758-1666
  • Fax: 818-758-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code229N00000X
TaxonomyAnaplastologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: JOHN MATTHEW STOLPE
Title or Position: BOARD CERTIFIED OCULARIST, BOARD AP
Credential: B.CO. ,B.A.D.O.
Phone: 818-758-1666