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General NPI Number Information
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NPI Number | 1609069301
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Entity Type | Organization
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Legal Business Name | KHODAI OPTOMETRIC VISION CENTER
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Dates
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Enumeration Date | 08/25/2007
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Last Update Date | 08/25/2007
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Provider Practice Location Address
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Address Line | 126 FRESCO LN
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City | PALM DESERT
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State | CA
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Zip | 92211-0772
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Country | US
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Telephone | 760-564-4430
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Fax |
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Provider Business Mailing Address
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Address Line | 126 FRESCO LN
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City | PALM DESERT
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State | CA
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Zip | 92211-0772
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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 | PRESIDENT
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Name | OMID KHODAI
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Credential | OD
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Telephone | 760-564-4430
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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 | 11263T
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License Number State | CA
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