Provider Demographics
NPI:1891054672
Name:MICHAEL W GETTIS OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:MICHAEL W GETTIS OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-670-1888
Mailing Address - Street 1:8610 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4008
Mailing Address - Country:US
Mailing Address - Phone:310-670-1888
Mailing Address - Fax:310-670-1343
Practice Address - Street 1:8610 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4008
Practice Address - Country:US
Practice Address - Phone:310-670-1888
Practice Address - Fax:310-670-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty