Provider Demographics
NPI:1093947723
Name:DR. MATTHEW ALPERT O.D. AND DR. JOSHUA CORBEN O.D., OPTOMETRIC CORPORA
Entity Type:Organization
Organization Name:DR. MATTHEW ALPERT O.D. AND DR. JOSHUA CORBEN O.D., OPTOMETRIC CORPORA
Other - Org Name:WINK OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:CORBEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-222-9465
Mailing Address - Street 1:4783 COMMONS WAY
Mailing Address - Street 2:UNIT C
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3368
Mailing Address - Country:US
Mailing Address - Phone:818-222-9465
Mailing Address - Fax:
Practice Address - Street 1:4783 COMMONS WAY
Practice Address - Street 2:UNIT C
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3368
Practice Address - Country:US
Practice Address - Phone:818-222-9465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
CA11995T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GC758AMedicare UPIN