Organization
EYEXAM OF CA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR TEDDER (REGIONAL DIRECTOR OF EYEXAM OF CA)
(805) 217-2974
Entity
Organization
Contact information
Practice address
1101 GLENDALE GALLERIA, GLENDALE, CA 91210-1301
(818) 552-4440
Mailing address
11751 RANCHITO ST, EL MONTE, CA 91732-1317
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
15134
CA
305R00000X
Preferred Provider Organization
15134
CA
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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