Organization
ADVANCED EYECARE PROFESSIONAL OPTOMETRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD V BLACK O.D. (OWNER)
(818) 240-0890
Entity
Organization
Contact information
Practice address
330 N BRAND BLVD, SUITE 110, GLENDALE, CA 91203-2308
(818) 240-0890
(808) 246-2540
Mailing address
330 N BRAND BLVD, SUITE 110, GLENDALE, CA 91203-2308
(818) 240-0890
(808) 246-2540
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT9869
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306035118
—
CA
Enumeration date
10/17/2007
Last updated
09/21/2009
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