Provider Demographics
NPI:1902083397
Name:DR GRACIE NER OPTOMETRY
Entity Type:Organization
Organization Name:DR GRACIE NER OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-913-0267
Mailing Address - Street 1:3145 GLENDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1805
Mailing Address - Country:US
Mailing Address - Phone:323-913-0267
Mailing Address - Fax:323-913-0264
Practice Address - Street 1:3145 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1805
Practice Address - Country:US
Practice Address - Phone:323-913-0267
Practice Address - Fax:323-913-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10773T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1270130001Medicare NSC