Provider Demographics
NPI:1245745215
Name:RAD OPTOMETRIC CARE INC
Entity Type:Organization
Organization Name:RAD OPTOMETRIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ALIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADZINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-428-8326
Mailing Address - Street 1:17840 MARGATE ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2223
Mailing Address - Country:US
Mailing Address - Phone:323-428-8326
Mailing Address - Fax:
Practice Address - Street 1:14006 RIVERSIDE DR STE 274
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1963
Practice Address - Country:US
Practice Address - Phone:818-461-0595
Practice Address - Fax:818-461-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty