Provider Demographics
NPI:1639557218
Name:PRIORITY VISION OPTOMETRY INC
Entity Type:Organization
Organization Name:PRIORITY VISION OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-536-9500
Mailing Address - Street 1:11964 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90304
Mailing Address - Country:US
Mailing Address - Phone:310-536-9500
Mailing Address - Fax:844-272-8842
Practice Address - Street 1:11964 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90304
Practice Address - Country:US
Practice Address - Phone:310-536-9500
Practice Address - Fax:844-272-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty