Provider Demographics
NPI:1619093663
Name:OLTA CORPORATION
Entity Type:Organization
Organization Name:OLTA CORPORATION
Other - Org Name:SITE FOR SORE EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:SERTIFIED OPTICIAN
Authorized Official - Phone:925-945-8300
Mailing Address - Street 1:1599 BOTELHO DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5102
Mailing Address - Country:US
Mailing Address - Phone:925-945-8300
Mailing Address - Fax:925-945-8757
Practice Address - Street 1:1599 BOTELHO DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5102
Practice Address - Country:US
Practice Address - Phone:925-945-8300
Practice Address - Fax:925-945-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA004285156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty