Provider Demographics
NPI:1417090606
Name:OLYMPIC OPTOMETRIC CENTER, INC., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:OLYMPIC OPTOMETRIC CENTER, INC., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-732-8111
Mailing Address - Street 1:16444 PARAMOUNT BLVD.
Mailing Address - Street 2:STE. 206
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5454
Mailing Address - Country:US
Mailing Address - Phone:323-732-8111
Mailing Address - Fax:323-638-2934
Practice Address - Street 1:16444 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5422
Practice Address - Country:US
Practice Address - Phone:323-732-8111
Practice Address - Fax:323-638-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty