Provider Demographics
NPI:1861652091
Name:DRS JOHN W & TERRI F STIBEL
Entity Type:Organization
Organization Name:DRS JOHN W & TERRI F STIBEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:F
Authorized Official - Last Name:STIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-315-9122
Mailing Address - Street 1:2730 WILSHIRE BLVD STE 545
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4745
Mailing Address - Country:US
Mailing Address - Phone:310-315-9122
Mailing Address - Fax:310-315-9122
Practice Address - Street 1:2730 WILSHIRE BLVD STE 545
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4745
Practice Address - Country:US
Practice Address - Phone:310-315-9122
Practice Address - Fax:310-315-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7457T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0283550001Medicare NSC