1356658611 NPI number — LOVATO FAMILY OPTOMETRIC CENTER, INC.

Table of content: (NPI 1356658611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356658611 NPI number — LOVATO FAMILY OPTOMETRIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOVATO FAMILY OPTOMETRIC CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356658611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4566 FLORENCE AVE
Provider Second Line Business Mailing Address:
STE. 6
Provider Business Mailing Address City Name:
CUDAHY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90201-4345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-773-3332
Provider Business Mailing Address Fax Number:
323-973-1797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4566 FLORENCE AVE
Provider Second Line Business Practice Location Address:
STE. 6
Provider Business Practice Location Address City Name:
CUDAHY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-773-3332
Provider Business Practice Location Address Fax Number:
323-973-1797
Provider Enumeration Date:
09/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LOVATO
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO/OPTOMETRIST
Authorized Official Telephone Number:
323-773-3332

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  10714T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SD0107140 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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