Provider Demographics
NPI:1801087952
Name:TEHILA ENTERPRISES INC
Entity type:Organization
Organization Name:TEHILA ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:OMMATYAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-792-1403
Mailing Address - Street 1:960 E GREEN ST
Mailing Address - Street 2:#162
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2401
Mailing Address - Country:US
Mailing Address - Phone:626-792-1403
Mailing Address - Fax:626-792-1403
Practice Address - Street 1:960 E GREEN ST
Practice Address - Street 2:#162
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2401
Practice Address - Country:US
Practice Address - Phone:626-792-1403
Practice Address - Fax:626-792-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141101332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1321580001Medicare NSC