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General NPI Number Information
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NPI Number | 1780019968
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Entity Type | Organization
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Legal Business Name | TOWN CENTER OPTOMETRY, INC.
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 1449 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4156
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Country | US
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Telephone | 323-723-3937
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Fax | 323-722-6204
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Provider Business Mailing Address
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Address Line | 1449 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4156
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Country | US
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Telephone | 323-723-3937
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Fax | 323-722-6204
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. HAROLD SUSUMU MASUDA
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Credential | O.D.
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Telephone | 323-723-3937
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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 | 8538TPG
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License Number State | CA
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