Provider Demographics
NPI:1881112340
Name:OLD TOWN OPTIX & OPTOMETRY, INC.
Entity type:Organization
Organization Name:OLD TOWN OPTIX & OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMARAZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-771-0715
Mailing Address - Street 1:78015 MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-3420
Mailing Address - Country:US
Mailing Address - Phone:760-771-0715
Mailing Address - Fax:760-771-2033
Practice Address - Street 1:78015 MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3420
Practice Address - Country:US
Practice Address - Phone:760-771-0715
Practice Address - Fax:760-771-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA6588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty