Provider Demographics
NPI:1033379367
Name:TOTAL VISION OPTOMETRY
Entity Type:Organization
Organization Name:TOTAL VISION OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PYKOSZ-SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-622-2200
Mailing Address - Street 1:405 STONEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3919
Mailing Address - Country:US
Mailing Address - Phone:562-622-2200
Mailing Address - Fax:562-622-9920
Practice Address - Street 1:405 STONEWOOD ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3919
Practice Address - Country:US
Practice Address - Phone:562-622-2200
Practice Address - Fax:562-622-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11735T261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU90329Medicare UPIN