Provider Demographics
NPI:1174665723
Name:MOSES ALBALAS OD PHD INC
Entity Type:Organization
Organization Name:MOSES ALBALAS OD PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTOMETRIC PROF CORPORATI
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBALAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD OD
Authorized Official - Phone:310-306-3737
Mailing Address - Street 1:12732 WASHINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2378
Mailing Address - Country:US
Mailing Address - Phone:310-306-3737
Mailing Address - Fax:310-306-2928
Practice Address - Street 1:12732 WASHINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2378
Practice Address - Country:US
Practice Address - Phone:310-306-3737
Practice Address - Fax:310-306-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5238T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty