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Organization
PALOS VERDES FAMILY VISION
Active
Organization
PALOS VERDES FAMILY VISION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY WHITESIDES HAWLEY O.D. (OWNER)
(310) 541-3411
Entity
Organization
Contact information
Practice address
827 DEEP VALLEY DR, SUITE 311, ROLLING HILLS ESTATES, CA 90274-3647
(310) 541-3411
Mailing address
827 DEEP VALLEY DR, SUITE 311, ROLLING HILLS ESTATES, CA 90274-3647
(310) 541-3411
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6947T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WY 209
PTAN
CA
Enumeration date
05/15/2007
Last updated
04/15/2013
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