Individual
ERIC BRUCE MCGREGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
14914 SHERMAN WAY, VAN NUYS, CA 91405-2113
(818) 787-2020
Mailing address
14914 SHERMAN WAY, VAN NUYS, CA 91405-2113
(818) 787-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11924T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
953987985
TAX ID
CA
01
—
W13323
GROUP
CA
01
—
WOP11924A
PPIN
CA
Enumeration date
07/07/2005
Last updated
12/01/2021
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