MEDICARE: ALLIED OPTICAL

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	33600005	CA

General Provider Information

NPI Number	:	1912115759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED OPTICAL

Provider Business Mailing Address
First Line	:	3601 JAMBOREE RD
Second Line	:	# 15 A
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2961
Country	:	US
Telephone Number	:	949-752-5636
Fax Number	:	949-752-5925

Provider Business Practice Location Address
First Line	:	3601 JAMBOREE RD
Second Line	:	# 15 A
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2961
Country	:	US
Telephone Number	:	949-752-5636
Fax Number	:	949-752-5925

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NOHA HAKIM
Credential	:
Telephone Number	:	949-752-5636

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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Directions to “ALLIED OPTICAL ” Practice Location

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