Provider Demographics
NPI:1104346642
Name:OPTOMETRIC ODYSSEY
Entity type:Organization
Organization Name:OPTOMETRIC ODYSSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-828-6262
Mailing Address - Street 1:2200 COLORADO AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3589
Mailing Address - Country:US
Mailing Address - Phone:310-828-6232
Mailing Address - Fax:310-828-5352
Practice Address - Street 1:2200 COLORADO AVE STE E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3589
Practice Address - Country:US
Practice Address - Phone:310-828-6232
Practice Address - Fax:310-828-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty