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General NPI Number Information
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NPI Number | 1144631763
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Entity Type | Organization
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Legal Business Name | PRECISION OPTOMETRIC CARE INC
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 1577 E CHEVY CHASE DR SUITE 120
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City | GLENDALE
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State | CA
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Zip | 91206-4107
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Country | US
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Telephone | 818-937-9980
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Fax | 818-937-9980
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Provider Business Mailing Address
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Address Line | 1577 E CHEVY CHASE DR SUITE 120
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City | GLENDALE
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State | CA
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Zip | 91206-4107
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Country | US
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Telephone | 818-937-9980
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Fax | 818-937-9983
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. HERMINEH MORADI
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Credential | O.D.
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Telephone | 818-937-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13048TPL
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License Number State | CA
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