Provider Demographics
NPI:1952589442
Name:OPTOMETRIX
Entity Type:Organization
Organization Name:OPTOMETRIX
Other - Org Name:DR. MYLES JOSEF ZAKHEIM,OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:JOSEF
Authorized Official - Last Name:ZAKHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-820-7866
Mailing Address - Street 1:11701 WILSHIRE BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1544
Mailing Address - Country:US
Mailing Address - Phone:310-820-7866
Mailing Address - Fax:310-826-4896
Practice Address - Street 1:11701 WILSHIRE BLVD STE 10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1544
Practice Address - Country:US
Practice Address - Phone:310-820-7866
Practice Address - Fax:310-286-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22330Medicare PIN