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Organization
MAISON OPTIQUE OPTOMETRIC CENTER
Active
Organization
MAISON OPTIQUE OPTOMETRIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT ENRIQUEZ TAMAYO O.D. (PARTNERSHIP/OPTOMETRIST)
(310) 325-7799
Entity
Organization
Contact information
Practice address
3525 PACIFIC COAST HWY, SUITE E, TORRANCE, CA 90505-6655
(310) 325-7799
(310) 325-7790
Mailing address
3525 PACIFIC COAST HWY, SUITE E, TORRANCE, CA 90505-6655
(310) 325-7799
(310) 325-7790
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10737TPL
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5436550001
MEDICARE DME-MAC
CA
05
—
GSD005160
—
CA
05
—
SDO107370
—
CA
05
—
SDO119690
—
CA
Enumeration date
10/27/2006
Last updated
12/08/2009
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