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General NPI Number Information
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NPI Number | 1245531425
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Entity Type | Organization
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Legal Business Name | DR LEE S BERMAN OPTOMETRY INC
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 1661 GOLDEN RAIN RD
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City | SEAL BEACH
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State | CA
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Zip | 90740-4907
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Country | US
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Telephone | 949-933-7301
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Fax | 714-903-7801
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Provider Business Mailing Address
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Address Line | 1365 DIVINITY DR
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City | PRESCOTT
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State | AZ
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Zip | 86301-7406
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Country | US
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Telephone | 949-933-7301
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Fax | 714-903-7801
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Authorized Official
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Title or Position | SOLE OWNER/CEO
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Name | LEE S BERMAN
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Credential | OD
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Telephone | 949-933-7301
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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 | CA5638T
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License Number State | CA
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