Provider Demographics
NPI:1649080623
Name:IP OPTOMETRIC EYE CARE INC
Entity type:Organization
Organization Name:IP OPTOMETRIC EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANSAWIRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-953-5861
Mailing Address - Street 1:5516 WILMA ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1231
Mailing Address - Country:US
Mailing Address - Phone:310-953-5861
Mailing Address - Fax:
Practice Address - Street 1:800 NEW LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3585
Practice Address - Country:US
Practice Address - Phone:805-222-3057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty