Provider Demographics
NPI:1588469167
Name:OPTICA OPTOMETRY VISION CENTER
Entity type:Organization
Organization Name:OPTICA OPTOMETRY VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:TAHIR
Authorized Official - Last Name:KHRAISHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-864-9323
Mailing Address - Street 1:16259 PARAMOUNT BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5425
Mailing Address - Country:US
Mailing Address - Phone:424-529-6645
Mailing Address - Fax:
Practice Address - Street 1:16259 PARAMOUNT BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5425
Practice Address - Country:US
Practice Address - Phone:424-529-6645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty