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General NPI Number Information
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NPI Number | 1780984187
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Entity Type | Organization
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Legal Business Name | SPECIALTY EYE CARE MEDICAL CENTER , INC
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 13739 RIVERSIDE DR STE A
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2417
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Country | US
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Telephone | 818-386-0008
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Fax | 818-386-0290
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Provider Business Mailing Address
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Address Line | 13739 RIVERSIDE DR STE A
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2417
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Country | US
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Telephone | 818-386-0008
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Fax | 818-386-0290
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Authorized Official
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Title or Position | PRESIDENT
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Name | KARINE GABRIELIAN
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Credential | M.D.
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Telephone | 818-386-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | A66613
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License Number State | CA
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