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Contact Information

PAUL J SUPER OD A PROFESSIONAL CORPORATION
11777 SAN VICENTE BLVD
#130
LOS ANGELES, CA90049-5011
 Phone: 310-820-2020
 Fax: 310-820-1884
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Corneal and Contact Management

152WC0802X 41 Optometry
 

Health Maintenance Organization

302R00000X
 

Low Vision Rehabilitation

152WL0500X 41 Optometry
 

Pediatrics

152WP0200X 41 Optometry
 

Vision Therapy

152WV0400X 41 Optometry
Indicates primary specialty

NPI Profile & details for PAUL J SUPER OD A PROFESSIONAL CORPORATION

NPI Number 1457681371
LBN Legal business name PAUL J SUPER OD A PROFESSIONAL CORPORATION
Authorized official PAUL SUPER - (OPTOMETRIST)
Entity Organization
Organization subpart 1 No
Enumeration date 12/29/2009
Last updated 03/03/2016 - About 10 years ago
Identifiers
CA License # OP8867TPG
CA License # OPT8867T
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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