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General NPI Number Information
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NPI Number | 1255883948
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Entity Type | Organization
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Legal Business Name | MODO OPTOMETRY A PROFESSIONAL OPTOMETRY CORP
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 4718 ADMIRALTY WAY 3/4
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6905
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Country | US
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Telephone | 310-305-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 4718 ADMIRALTY WAY
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MR. ARMIN RAFIEE
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Credential | OD
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Telephone | 310-305-2950
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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 | 10307
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License Number State | CA
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