Provider Demographics
NPI:1396259669
Name:EYE PEOPLE OPTOMETRY, INC.
Entity type:Organization
Organization Name:EYE PEOPLE OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:424-346-2845
Mailing Address - Street 1:2156 MONTEBELLO TOWN CTR
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2170
Mailing Address - Country:US
Mailing Address - Phone:323-720-1600
Mailing Address - Fax:323-278-7595
Practice Address - Street 1:2156 MONTEBELLO TOWN CTR
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2170
Practice Address - Country:US
Practice Address - Phone:323-720-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-25
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15317TLG152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty