Provider Demographics
NPI:1407043532
Name:A.B.SEE OPTICAL
Entity Type:Organization
Organization Name:A.B.SEE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:VADIM
Authorized Official - Last Name:MIRETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-933-1616
Mailing Address - Street 1:8488 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4112
Mailing Address - Country:US
Mailing Address - Phone:310-666-9702
Mailing Address - Fax:323-951-0694
Practice Address - Street 1:8488 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4112
Practice Address - Country:US
Practice Address - Phone:310-666-9702
Practice Address - Fax:323-951-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX006045FMedicaid