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General NPI Number Information
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NPI Number | 1235680802
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Entity Type | Organization
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Legal Business Name | WIZARD OF EYES OPTICAL
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 17205 VENTURA BLVD UNIT A
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City | ENCINO
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State | CA
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Zip | 91316-4007
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Country | US
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Telephone | 818-784-3333
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Fax | 818-783-4438
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Provider Business Mailing Address
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Address Line | 17205 VENTURA BLVD UNIT A
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City | ENCINO
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State | CA
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Zip | 91316-4007
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Country | US
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Telephone | 818-784-3333
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JASON NED WEISER
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Credential | OPTICAN
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Telephone | 818-784-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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