Provider Demographics
NPI:1033358205
Name:SMARTEYES OPTOMETRY
Entity Type:Organization
Organization Name:SMARTEYES OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-393-8885
Mailing Address - Street 1:518 E LONGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5352
Mailing Address - Country:US
Mailing Address - Phone:626-393-8885
Mailing Address - Fax:626-821-5380
Practice Address - Street 1:25 E HUNTINGTON DR
Practice Address - Street 2:SUITE #111
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3210
Practice Address - Country:US
Practice Address - Phone:626-393-8885
Practice Address - Fax:626-821-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12911302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0129110Medicaid
CASD0129110Medicaid
CAV10286Medicare UPIN