Provider Demographics
NPI:1568137669
Name:GOTTLIEB OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:GOTTLIEB OPTOMETRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-454-9888
Mailing Address - Street 1:322 LAKEWOOD CENTER MALL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2409
Mailing Address - Country:US
Mailing Address - Phone:562-630-2020
Mailing Address - Fax:562-633-7220
Practice Address - Street 1:322 LAKEWOOD CENTER MALL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2409
Practice Address - Country:US
Practice Address - Phone:562-630-2020
Practice Address - Fax:562-633-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty