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Organization
SOUTH GATE OPTOMETRY INC
Active
Organization
SOUTH GATE OPTOMETRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNA M PENNINO O.D. (OWNER)
(323) 566-6183
Entity
Organization
Contact information
Practice address
3329 TWEEDY BLVD, SOUTH GATE, CA 90280-4324
(323) 566-6183
Mailing address
3329 TWEEDY BLVD, SOUTH GATE, CA 90280-4324
(323) 566-6183
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9996T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0099960
—
CA
Enumeration date
08/21/2007
Last updated
02/19/2009
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