Provider Demographics
NPI:1518666544
Name:WESTSIDE VISION OPTOMETRY PC
Entity Type:Organization
Organization Name:WESTSIDE VISION OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-283-2231
Mailing Address - Street 1:5600 WILSHIRE BLVD APT 640
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10250 SANTA MONICA BLVD
Practice Address - Street 2:#2550
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:424-249-1957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty