Provider Demographics
NPI:1053461459
Name:FELDMAN, MAURICE (OD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 E LOS ANGELES AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2848
Mailing Address - Country:US
Mailing Address - Phone:805-526-0842
Mailing Address - Fax:805-526-1221
Practice Address - Street 1:1420 E LOS ANGELES AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2848
Practice Address - Country:US
Practice Address - Phone:805-526-0842
Practice Address - Fax:805-526-1221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8224T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0082240Medicaid
CAU08300Medicare UPIN
OP8224Medicare ID - Type Unspecified