Provider Demographics
NPI:1518241983
Name:GLASS HOUSE OPTOMETRY INC
Entity Type:Organization
Organization Name:GLASS HOUSE OPTOMETRY INC
Other - Org Name:BELMONT HEIGHTS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SINAVY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-433-1700
Mailing Address - Street 1:4203 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2922
Mailing Address - Country:US
Mailing Address - Phone:562-433-1700
Mailing Address - Fax:
Practice Address - Street 1:4203 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2922
Practice Address - Country:US
Practice Address - Phone:562-433-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13026TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFL800AMedicare PIN