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General NPI Number Information
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NPI Number | 1194291294
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Entity Type | Organization
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Legal Business Name | POOLSAAD FAMILY VISION OPTOMETRY INC
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 8135 PAINTER AVE STE 100
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City | WHITTIER
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State | CA
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Zip | 90602-3159
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Country | US
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Telephone | 609-351-4395
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 N LAKEWOOD BLVD APT 6
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City | LONG BEACH
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State | CA
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Zip | 90808-1066
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Country | US
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Telephone | 609-351-4395
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JANA GIEBEL
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Credential | OD
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Telephone | 609-351-4395
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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 |
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License Number State |
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