MEDICARE: MITCHELL C LATTER MD INC A PROF CORP

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	G40013	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255411625	OTHER	CA	NPI TYPE 1
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356469365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL C LATTER MD INC A PROF CORP

Provider Business Mailing Address
First Line	:	1499 HUNTINGTON DRIVE
Second Line	:	SUITE 508
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-5464
Country	:	US
Telephone Number	:	626-799-9588
Fax Number	:	626-799-9339

Provider Business Practice Location Address
First Line	:	1499 HUNTINGTON DRIVE
Second Line	:	SUITE 508
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-5464
Country	:	US
Telephone Number	:	626-799-9588
Fax Number	:	626-799-9339

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MITCHELL CURTIS LATTER
Credential	:	MD
Telephone Number	:	626-799-9588

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	12/09/2011

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