MEDICARE: MOSES ALBALAS OD PHD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5238T	CA

General Provider Information

NPI Number	:	1174665723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSES ALBALAS OD PHD INC

Provider Business Mailing Address
First Line	:	12732 WASHINGTON BLVD
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2378
Country	:	US
Telephone Number	:	310-306-3737
Fax Number	:	310-306-2928

Provider Business Practice Location Address
First Line	:	12732 WASHINGTON BLVD
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2378
Country	:	US
Telephone Number	:	310-306-3737
Fax Number	:	310-306-2928

Authorized Official
Title or Position	:	PRESIDENT OPTOMETRIC PROF CORPORATI
Name	:	DR. MOSES ALBALAS
Credential	:	PHD OD
Telephone Number	:	310-306-3737

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/22/2020

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