Provider Demographics
NPI:1245386960
Name:EYEXAM OF CALIFORNIA
Entity Type:Organization
Organization Name:EYEXAM OF CALIFORNIA
Other - Org Name:LENSCRAFTERS #0874
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3534
Mailing Address - Street 1:195 SANTA MONICA PL
Mailing Address - Street 2:SANTA MONICA PLACE #195
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2364
Mailing Address - Country:US
Mailing Address - Phone:310-393-2341
Mailing Address - Fax:
Practice Address - Street 1:195 SANTA MONICA PL
Practice Address - Street 2:SANTA MONICA PLACE #195
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2364
Practice Address - Country:US
Practice Address - Phone:310-393-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0180150923Medicare NSC