MEDICARE: COMPLETE EYE CARE CENTER

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	156FX1800X	Optician	03621	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9231	OTHER	CA	MEDICAL EYE SERVICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265658694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE EYE CARE CENTER

Provider Business Mailing Address
First Line	:	17001 HAWTHORNE BLVD
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3302
Country	:	US
Telephone Number	:	310-370-7575
Fax Number	:	310-370-6227

Provider Business Practice Location Address
First Line	:	17001 HAWTHORNE BLVD
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3302
Country	:	US
Telephone Number	:	310-370-7575
Fax Number	:	310-370-6227

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ADAM ROSSIE
Credential	:
Telephone Number	:	310-370-7575

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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Directions to “COMPLETE EYE CARE CENTER ” Practice Location

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