Provider Demographics
NPI:1780019968
Name:TOWN CENTER OPTOMETRY, INC.
Entity Type:Organization
Organization Name:TOWN CENTER OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:SUSUMU
Authorized Official - Last Name:MASUDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-723-3937
Mailing Address - Street 1:1449 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4156
Mailing Address - Country:US
Mailing Address - Phone:323-723-3937
Mailing Address - Fax:323-722-6204
Practice Address - Street 1:1449 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4156
Practice Address - Country:US
Practice Address - Phone:323-723-3937
Practice Address - Fax:323-722-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8538TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780614545Medicaid