Provider Demographics
NPI:1932511383
Name:OCONNOR OD OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:OCONNOR OD OPTOMETRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-994-9201
Mailing Address - Street 1:3840 CROSS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4933
Mailing Address - Country:US
Mailing Address - Phone:310-994-9201
Mailing Address - Fax:310-456-0430
Practice Address - Street 1:3840 CROSS CREEK RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4933
Practice Address - Country:US
Practice Address - Phone:310-994-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6766TG261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center