Provider Demographics
NPI:1841837242
Name:HOLLYWOOD OPTOMETRIST
Entity type:Organization
Organization Name:HOLLYWOOD OPTOMETRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERMIN
Authorized Official - Middle Name:LAHIJANI
Authorized Official - Last Name:O.D.
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-667-2102
Mailing Address - Street 1:1300 N VERMONT AVE STE 703
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6089
Mailing Address - Country:US
Mailing Address - Phone:323-667-2102
Mailing Address - Fax:323-927-1799
Practice Address - Street 1:1300 N VERMONT AVE STE 703
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6089
Practice Address - Country:US
Practice Address - Phone:323-667-2102
Practice Address - Fax:323-927-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1790169472OtherOTHER
CA1801093570OtherOTHER
CA1891764833OtherOTHER