Individual
EUGENE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1818 S WESTERN AVE, STE.101, LOS ANGELES, CA 90006-5807
(323) 731-2474
(323) 731-9408
Mailing address
876 S NORTON AVE, LOS ANGELES, CA 90005-3656
(323) 731-2474
(323) 731-9408
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT7673TPL
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD007630
—
CA
05
—
SD0076731
—
CA
Enumeration date
01/24/2007
Last updated
07/08/2007
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