Provider Demographics
NPI:1912518887
Name:OCONNOR OPTOMETRIC INC
Entity Type:Organization
Organization Name:OCONNOR OPTOMETRIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:VINCENTE
Authorized Official - Last Name:SAMPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-994-9202
Mailing Address - Street 1:23401 CIVIC CENTER WAY
Mailing Address - Street 2:UNIT 2B
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:424-235-2488
Mailing Address - Fax:
Practice Address - Street 1:23401 CIVIC CENTER WAY
Practice Address - Street 2:UNIT 2B
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265
Practice Address - Country:US
Practice Address - Phone:424-235-2488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty