Provider Demographics
NPI:1205171394
Name:GLENVIEW OPTICAL
Entity type:Organization
Organization Name:GLENVIEW OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-247-5910
Mailing Address - Street 1:515 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3388
Mailing Address - Country:US
Mailing Address - Phone:818-247-5910
Mailing Address - Fax:818-247-5919
Practice Address - Street 1:515 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3388
Practice Address - Country:US
Practice Address - Phone:818-247-5910
Practice Address - Fax:818-247-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL74332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ74745ZMedicaid
CAZZZ74745ZMedicaid