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General NPI Number Information
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NPI Number | 1316270721
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Entity Type | Organization
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Legal Business Name | BURBANK OPTOMETRIC CENTER, INC
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 1032 N HOLLYWOOD WAY
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City | BURBANK
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State | CA
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Zip | 91505-2525
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Country | US
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Telephone | 818-845-3549
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Fax |
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Provider Business Mailing Address
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Address Line | 1032 N HOLLYWOOD WAY
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City | BURBANK
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State | CA
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Zip | 91505-2525
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Country | US
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Telephone | 818-845-3549
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LORI SACHIKO NISHIDA-EUGENIO
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Credential | OD
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Telephone | 818-845-3549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 9994T
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License Number State | CA
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