Provider Demographics
NPI:1063853083
Name:LAMOUCHI, MANEL (OD)
Entity Type:Individual
Prefix:
First Name:MANEL
Middle Name:
Last Name:LAMOUCHI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13173 BLACK MOUNTAIN RD STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2687
Mailing Address - Country:US
Mailing Address - Phone:858-538-6695
Mailing Address - Fax:858-538-3182
Practice Address - Street 1:13173 BLACK MOUNTAIN RD STE 7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2687
Practice Address - Country:US
Practice Address - Phone:858-538-6695
Practice Address - Fax:858-538-3182
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33354152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist