Organization
GLENDALE OPTOMETRIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY TAWNIE GIN O.D. (OPTOMETRIST)
(818) 243-1300
Entity
Organization
Contact information
Practice address
308 E BROADWAY, GLENDALE, CA 91205-1011
(818) 243-1300
Mailing address
308 E BROADWAY, GLENDALE, CA 91205-1011
(818) 243-1300
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
13022
CA
Other
Enumeration date
06/27/2007
Last updated
04/09/2008
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