Provider Demographics
NPI:1881795292
Name:TOTAL VISION OPTOMETRY CENTER, INC
Entity type:Organization
Organization Name:TOTAL VISION OPTOMETRY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIARTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-988-4450
Mailing Address - Street 1:13521 SHERMAN WAY
Mailing Address - Street 2:SUITE I
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2894
Mailing Address - Country:US
Mailing Address - Phone:818-988-4450
Mailing Address - Fax:818-988-4485
Practice Address - Street 1:13521 SHERMAN WAY
Practice Address - Street 2:SUITE I
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2894
Practice Address - Country:US
Practice Address - Phone:818-988-4450
Practice Address - Fax:818-988-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA8747T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty