PAUL J SUPER OD A PROFESSIONAL CORPORATION
Managed Care Organizations at San Vicente Blvd, Los Angeles, CA

License number
California OP8867TPG
Category
Optometry
Type
Optometrist
License number
California OP8867TPG
Category
Optometry
Type
Corneal and Contact Management
License number
California OP8867TPG
Category
Optometry
Type
Low Vision Rehabilitation
License number
California OP8867TPG
Category
Optometry
Type
Pediatrics
License number
California OP8867TPG
Category
Optometry
Type
Vision Therapy
License number
California OPT8867T
Category
Managed Care Organizations
Type
Health Maintenance Organization
Owner
Name: DR. PAUL J SUPER O.D.
Title: OPTOMETRIST
Phone: (310) 820-2020
Address
Address
11777 San Vicente Blvd #130, Los Angeles, CA 90049
National Provider ID: 1457681371
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PAUL J. SUPER, O.D., A PROFESSIONAL CORPORATION

11777 San Vicente Blvd STE 130, Los Angeles, CA 90049

Registration:
Feb 23, 1994
State ID:
C1739618
Business type:
Articles of Incorporation
President:
J. Paul (President)
Agent:
Paul J Super,Beverly Hills, CA 90210 (Physical)

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