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General NPI Number Information
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NPI Number | 1780700583
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Entity Type | Organization
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Legal Business Name | VISUALEYES OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 14429 1/2 VENTURA BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2674
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Country | US
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Telephone | 818-783-8750
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Fax | 818-783-8779
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Provider Business Mailing Address
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Address Line | 14429 1/2 VENTURA BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91423
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Country | US
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Telephone | 818-783-8750
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Fax | 818-783-8779
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. LEE EDWARD DODGE IV
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Credential | O.D.
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Telephone | 818-783-8750
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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 | 12800T
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License Number State | CA
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