Provider Demographics
NPI:1851979439
Name:OPTICAL TIME, INC.
Entity Type:Organization
Organization Name:OPTICAL TIME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:SISSAG
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGHIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPA
Authorized Official - Phone:213-304-7477
Mailing Address - Street 1:18725 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3302
Mailing Address - Country:US
Mailing Address - Phone:818-344-7100
Mailing Address - Fax:818-344-7107
Practice Address - Street 1:18725 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3302
Practice Address - Country:US
Practice Address - Phone:818-344-7100
Practice Address - Fax:818-344-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty