Provider Demographics
NPI:1669666723
Name:CLEAR VISION OPTOMETRY, INC.
Entity Type:Organization
Organization Name:CLEAR VISION OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-769-2020
Mailing Address - Street 1:1101 TRUMAN ST
Mailing Address - Street 2:STE E
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3237
Mailing Address - Country:US
Mailing Address - Phone:818-361-2020
Mailing Address - Fax:
Practice Address - Street 1:5269 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3111
Practice Address - Country:US
Practice Address - Phone:818-769-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12233T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0122331Medicaid
CAU96647Medicare UPIN
CAW18814Medicare PIN
CASD0122331Medicaid