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General NPI Number Information
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NPI Number | 1649080623
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Entity Type | Organization
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Legal Business Name | IP OPTOMETRIC EYE CARE INC
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 800 NEW LOS ANGELES AVE
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City | MOORPARK
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State | CA
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Zip | 93021-3585
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Country | US
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Telephone | 805-222-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 5516 WILMA ST
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City | TORRANCE
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State | CA
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Zip | 90503-1231
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Country | US
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Telephone | 310-953-5861
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRIN PANSAWIRA
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Credential | OD
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Telephone | 310-953-5861
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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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