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General NPI Number Information
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NPI Number | 1619402476
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Entity Type | Organization
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Legal Business Name | VISUAL PARADISE OPTOMETRY, INC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 602 THE SHOPS AT MISSION VIEJO
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6515
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Country | US
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Telephone | 949-582-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 602 THE SHOPS AT MISSION VIEJO
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6515
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Country | US
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Telephone | 949-582-2020
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST, OWNER
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Name | DR. DIANA CIOBANU
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Credential | O.D.
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Telephone | 617-270-6527
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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 | 12974T
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License Number State | CA
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