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General NPI Number Information
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NPI Number | 1285823138
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Entity Type | Organization
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Legal Business Name | EYEMAX OPTOMETRY INC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 2097 N TUSTIN ST
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City | ORANGE
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State | CA
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Zip | 92865-3901
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Country | US
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Telephone | 714-637-9999
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Fax | 714-637-9993
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Provider Business Mailing Address
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Address Line | 2097 N TUSTIN ST
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City | ORANGE
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State | CA
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Zip | 92865-3901
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Country | US
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Telephone | 714-637-9999
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Fax | 714-637-9993
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | TERRY METSOVAS
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Credential | O.D.
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Telephone | 714-637-9999
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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 | 10460T
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License Number State | CA
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