Provider Demographics
NPI:1114977089
Name:ROGERS AND OSTERLOH OPTOMETRY
Entity Type:Organization
Organization Name:ROGERS AND OSTERLOH OPTOMETRY
Other - Org Name:EYES ON L.A. OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:ABDC
Authorized Official - Phone:805-552-0004
Mailing Address - Street 1:251 W LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1869
Mailing Address - Country:US
Mailing Address - Phone:805-552-0004
Mailing Address - Fax:805-552-0005
Practice Address - Street 1:251 W LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1869
Practice Address - Country:US
Practice Address - Phone:805-552-0004
Practice Address - Fax:805-552-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP3203152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19838Medicare PIN
CAU63791Medicare UPIN