Provider Demographics
NPI:1649224049
Name:MORE VISION EYE CARE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MORE VISION EYE CARE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-662-9629
Mailing Address - Street 1:5181 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6113
Mailing Address - Country:US
Mailing Address - Phone:323-662-9629
Mailing Address - Fax:323-662-0915
Practice Address - Street 1:5181 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6113
Practice Address - Country:US
Practice Address - Phone:323-662-9629
Practice Address - Fax:323-662-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20843156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty