Provider Demographics
NPI:1619402476
Name:VISUAL PARADISE OPTOMETRY, INC
Entity type:Organization
Organization Name:VISUAL PARADISE OPTOMETRY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIOBANU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-270-6527
Mailing Address - Street 1:602 THE SHOPS AT MISSION VIEJO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6515
Mailing Address - Country:US
Mailing Address - Phone:949-582-2020
Mailing Address - Fax:
Practice Address - Street 1:602 THE SHOPS AT MISSION VIEJO
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6515
Practice Address - Country:US
Practice Address - Phone:949-582-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISUAL PARADISE OPTOMETRY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12974T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty