| NPI | 1619257052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA MARIE PERALTA Billing Supervisor 661-665-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA SD0116921) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2011-08-17 |