Provider Demographics
NPI:1689609257
Name:ARROW VISION CENTER OPTOMETRY, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:ARROW VISION CENTER OPTOMETRY, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BETTELHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-914-2414
Mailing Address - Street 1:601 W ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5411
Mailing Address - Country:US
Mailing Address - Phone:626-914-2414
Mailing Address - Fax:626-335-2635
Practice Address - Street 1:601 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5411
Practice Address - Country:US
Practice Address - Phone:626-914-2414
Practice Address - Fax:626-335-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8672 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004990Medicaid
CADS5852Medicare PIN
CAWY143Medicare PIN