=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225273600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AYLA CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2008
-----------------------------------------------------
Last Update Date | 03/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 164 W HOSPITALITY LN STE 7
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-383-5000
-----------------------------------------------------
Fax | 909-383-5010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 164 W HOSPITALITY LN STE 7
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-383-5000
-----------------------------------------------------
Fax | 909-383-5010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF OPTOMETRY
-----------------------------------------------------
Name | DR. CYNTHIA A CORBETT
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 909-383-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 11346T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------