Organization
FRAMES, LENSES, ETC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLGA MUKACHEVA (GENERAL PARTNER)
(323) 317-2093
Entity
Organization
Contact information
Practice address
7626 SANTA MONICA BLVD, WEST HOLLYWOOD, CA 90046-6409
(323) 317-2093
Mailing address
5741 CARLTON WAY, #210, LOS ANGELES, CA 90028-6754
(323) 317-2093
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
7338
CA
Other
Enumeration date
06/11/2008
Last updated
06/11/2008
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