Provider Demographics
NPI:1184830101
Name:OPTIPLEX EYEWEAR
Entity Type:Organization
Organization Name:OPTIPLEX EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOHRABYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-545-9965
Mailing Address - Street 1:1129 E BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4632
Mailing Address - Country:US
Mailing Address - Phone:818-545-9965
Mailing Address - Fax:818-545-9957
Practice Address - Street 1:1129 E BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4632
Practice Address - Country:US
Practice Address - Phone:818-545-9965
Practice Address - Fax:818-545-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7196305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service