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Organization
PAUL J SUPER OD A PROFESSIONAL CORPORATION
Active
Organization
PAUL J SUPER OD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL J SUPER O.D. (OPTOMETRIST)
(310) 820-2020
Entity
Organization
Contact information
Practice address
11777 SAN VICENTE BLVD, #130, LOS ANGELES, CA 90049-5011
(310) 820-2020
(310) 820-1884
Mailing address
11777 SAN VICENTE BLVD, #130, LOS ANGELES, CA 90049-5011
(310) 820-2020
(310) 820-1884
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP8867TPG
CA
152WC0802X
Corneal and Contact Management Optometrist
OP8867TPG
CA
152WL0500X
Low Vision Rehabilitation Optometrist
OP8867TPG
CA
152WP0200X
Pediatric Optometrist
OP8867TPG
CA
152WV0400X
Vision Therapy Optometrist
OP8867TPG
CA
302R00000X
Health Maintenance Organization
OPT8867T
CA
Other
Enumeration date
12/29/2009
Last updated
03/03/2016
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