Provider Demographics
NPI:1093992406
Name:EILEEN J. BELL
Entity Type:Organization
Organization Name:EILEEN J. BELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-414-9595
Mailing Address - Street 1:302 W GRAND AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3700
Mailing Address - Country:US
Mailing Address - Phone:310-414-9595
Mailing Address - Fax:310-414-0137
Practice Address - Street 1:302 W GRAND AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3700
Practice Address - Country:US
Practice Address - Phone:310-414-9595
Practice Address - Fax:310-414-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8192 T152W00000X
CA12119 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023191913OtherTYPE 1 NPI
CA0925260001Medicare NSC
CAWY106Medicare PIN