Provider Demographics
NPI:1780700583
Name:VISUALEYES OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:VISUALEYES OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:IV
Authorized Official - Credentials:OD
Authorized Official - Phone:818-783-8750
Mailing Address - Street 1:14429 1/2 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423
Mailing Address - Country:US
Mailing Address - Phone:818-783-8750
Mailing Address - Fax:818-783-8779
Practice Address - Street 1:14429 1/2 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2674
Practice Address - Country:US
Practice Address - Phone:818-783-8750
Practice Address - Fax:818-783-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12800T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty