Provider Demographics
NPI:1679674626
Name:HOWARD E STEIN OD AN OPTOMETRIC CORP
Entity Type:Organization
Organization Name:HOWARD E STEIN OD AN OPTOMETRIC CORP
Other - Org Name:STEIN OPTOMETRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-546-5568
Mailing Address - Street 1:3200 N SEPULVEDA BLVD
Mailing Address - Street 2:STE. E4
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2458
Mailing Address - Country:US
Mailing Address - Phone:310-546-5568
Mailing Address - Fax:310-546-5421
Practice Address - Street 1:3200 N SEPULVEDA BLVD
Practice Address - Street 2:STE. E4
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2458
Practice Address - Country:US
Practice Address - Phone:310-546-5568
Practice Address - Fax:310-546-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004470Medicaid
CADO605AMedicare UPIN