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NPI Code Detail

MEDICARE: CORBEN OPTOMETRY INC

MEDICARE: CORBEN OPTOMETRY 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
1152W00000XOptometrist4954TCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11912011560OTHERCANPI
21043297666OTHERCANPI INDIVIDUAL

General Provider Information

NPI Number : 1801910096
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORBEN OPTOMETRY INC
Provider Business Mailing Address
First Line : 23206 LYONS AVE STE 102
Second Line :
City : NEWHALL
State : CA
Zip : 91321-2671
Country : US
Telephone Number : 661-259-2168
Fax Number : 661-259-3568
Provider Business Practice Location Address
First Line : 23206 LYONS AVE STE 102
Second Line :
City : NEWHALL
State : CA
Zip : 91321-2671
Country : US
Telephone Number : 661-259-2168
Fax Number : 661-259-3568
Authorized Official
Title or Position : V.P.
Name : DR. JOSHUA ADAM CORBEN
Credential : O.D.
Telephone Number : 661-259-2168
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/22/2020

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Directions to “CORBEN OPTOMETRY INC ” Practice Location

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