Provider Demographics
NPI:1134618986
Name:OPTIKOS
Entity type:Organization
Organization Name:OPTIKOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:213-386-0001
Mailing Address - Street 1:3680 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:213-386-0001
Mailing Address - Fax:213-386-1001
Practice Address - Street 1:3680 WILSHIRE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:213-386-0001
Practice Address - Fax:213-386-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty