Provider Demographics
NPI:1235680802
Name:WIZARD OF EYES OPTICAL
Entity Type:Organization
Organization Name:WIZARD OF EYES OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:NED
Authorized Official - Last Name:WEISER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICAN
Authorized Official - Phone:818-784-3333
Mailing Address - Street 1:17205 VENTURA BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4007
Mailing Address - Country:US
Mailing Address - Phone:818-784-3333
Mailing Address - Fax:
Practice Address - Street 1:17205 VENTURA BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4007
Practice Address - Country:US
Practice Address - Phone:818-784-3333
Practice Address - Fax:818-783-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site