MEDICARE: FARO OPTOMETRY

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	11257 TLG	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194181248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARO OPTOMETRY

Provider Business Mailing Address
First Line	:	4433 S ALAMEDA ST
Second Line	:	SUITE C12
City	:	LOS ANGELES
State	:	CA
Zip	:	90058-2008
Country	:	US
Telephone Number	:	323-988-1033
Fax Number	:	888-260-4874

Provider Business Practice Location Address
First Line	:	4433 S ALAMEDA ST
Second Line	:	SUITE C12
City	:	LOS ANGELES
State	:	CA
Zip	:	90058-2008
Country	:	US
Telephone Number	:	323-988-1033
Fax Number	:	888-260-4874

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALI A MOHEBBI
Credential	:	OD
Telephone Number	:	323-988-1033

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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Directions to “FARO OPTOMETRY ” Practice Location

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