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General NPI Number Information
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NPI Number | 1396259669
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Entity Type | Organization
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Legal Business Name | EYE PEOPLE OPTOMETRY, INC.
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Dates
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Enumeration Date | 11/25/2017
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 2156 MONTEBELLO TOWN CTR
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City | MONTEBELLO
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State | CA
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Zip | 90640-2170
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Country | US
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Telephone | 323-720-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 2156 MONTEBELLO TOWN CTR
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City | MONTEBELLO
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State | CA
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Zip | 90640-2170
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Country | US
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Telephone | 323-720-1600
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Fax | 323-278-7595
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER KHEM
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Credential | OD
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Telephone | 424-346-2845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 15317TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 15317TLG
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 15317TLG
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License Number State | CA
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