Organization
EXPRESS LENS LAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN KEITH GOLDSTONE (PRESIDENT)
(714) 545-1024
Entity
Organization
Contact information
Practice address
17150 NEWHOPE ST, SUITE 305, FOUNTAIN VALLEY, CA 92708-4250
(714) 545-1024
(714) 556-2026
Mailing address
17150 NEWHOPE ST, SUITE 305, FOUNTAIN VALLEY, CA 92708-4250
(714) 545-1024
(714) 556-2026
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
19209
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
772534
—
AZ
05
—
88272567
—
NM
Enumeration date
12/28/2006
Last updated
08/22/2020
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