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General NPI Number Information
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NPI Number | 1417090606
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Entity Type | Organization
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Legal Business Name | OLYMPIC OPTOMETRIC CENTER, INC., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 16444 PARAMOUNT BLVD SUITE 206
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City | PARAMOUNT
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State | CA
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Zip | 90723-5422
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Country | US
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Telephone | 323-732-8111
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Fax | 323-638-2934
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Provider Business Mailing Address
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Address Line | 16444 PARAMOUNT BLVD. STE. 206
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City | PARAMOUNT
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State | CA
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Zip | 90723-5454
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Country | US
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Telephone | 323-732-8111
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Fax | 323-638-2934
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LORIE J. KOOK
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Credential | O.D.
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Telephone | 323-732-8111
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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 |
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License Number State |
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