MEDICARE: LONG BEACH OPTOMETRIC GROUP 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

General Provider Information

NPI Number	:	1770682221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH OPTOMETRIC GROUP INC.

Provider Business Mailing Address
First Line	:	4275 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2801
Country	:	US
Telephone Number	:	562-595-5662
Fax Number	:	562-988-2082

Provider Business Practice Location Address
First Line	:	4275 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2801
Country	:	US
Telephone Number	:	562-595-5662
Fax Number	:	562-988-2082

Authorized Official
Title or Position	:	PARTNER
Name	:	RICHARD NATHAN FRIEDER
Credential	:	O.D.
Telephone Number	:	562-595-5662

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/22/2020

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