Provider Demographics
NPI:1194181248
Name:FARO OPTOMETRY
Entity Type:Organization
Organization Name:FARO OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHEBBI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-988-1033
Mailing Address - Street 1:4433 S ALAMEDA ST
Mailing Address - Street 2:SUITE C12
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90058-2008
Mailing Address - Country:US
Mailing Address - Phone:323-988-1033
Mailing Address - Fax:888-260-4874
Practice Address - Street 1:4433 S ALAMEDA ST
Practice Address - Street 2:SUITE C12
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90058-2008
Practice Address - Country:US
Practice Address - Phone:323-988-1033
Practice Address - Fax:888-260-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11257 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD011257CAMedicaid
CADW811ZMedicare UPIN