Provider Demographics
NPI:1336334994
Name:RICHARD PALACIOS OD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD PALACIOS OD, A PROFESSIONAL CORPORATION
Other - Org Name:SEE WORLD OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-888-5450
Mailing Address - Street 1:21918 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1724
Mailing Address - Country:US
Mailing Address - Phone:818-888-5450
Mailing Address - Fax:818-888-8737
Practice Address - Street 1:21918 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1724
Practice Address - Country:US
Practice Address - Phone:818-888-5450
Practice Address - Fax:818-888-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty