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Organization
MARSHALL B. KETCHUM UNIVERSITY/UNIVERSITY EYE CENTER AT LOS ANGELES
Active
Organization
MARSHALL B. KETCHUM UNIVERSITY/UNIVERSITY EYE CENTER AT LOS ANGELES
Active
Parent organization
MARSHALL B. KETCHUM UNIVERSITY
Other names
Optometric Center of Los Angeles
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARSHALL B. KETCHUM UNIVERSITY
Authorized official
MARK E. NAKENO O.D. (CLINIC DIRECTOR)
(323) 234-9137
Entity
Organization
Contact information
Practice address
3916 S. BROADWAY, LOS ANGELES, CA 90037
(323) 234-9137
(323) 235-6203
Mailing address
3916 S. BROADWAY, LOS ANGELES, CA 90037
(323) 234-9137
(323) 235-6203
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
5827 TPL
CA
152W00000X
Optometrist
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT 11740F
—
CA
05
—
ZZT11740F
—
CA
Enumeration date
09/16/2006
Last updated
10/08/2015
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