Organization
BEVERLY GROVE VISION CARE OPTOMETRY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIELLE TAMMY ROTH OD (DOCTOR)
(323) 879-9259
Entity
Organization
Contact information
Practice address
511 S FAIRFAX AVE, LOS ANGELES, CA 90036-3130
(323) 879-9259
Mailing address
511 S FAIRFAX AVE, LOS ANGELES, CA 90036-3130
(323) 879-9259
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
14623TLG
CA
Other
Enumeration date
09/29/2017
Last updated
07/21/2022
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