MEDICARE: COLE VISION CORPORATION

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1255489589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLE VISION CORPORATION

Provider Business Mailing Address
First Line	:	5601 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2903
Country	:	US
Telephone Number	:	323-769-2603
Fax Number	:	323-463-1358

Provider Business Practice Location Address
First Line	:	5601 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2903
Country	:	US
Telephone Number	:	323-769-2603
Fax Number	:	323-463-1358

Authorized Official
Title or Position	:	MEDICARE SUPERVISOR
Name	:	MS. WENDY UHLS
Credential	:
Telephone Number	:	513-765-3534

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2020

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Directions to “COLE VISION CORPORATION ” Practice Location

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