Provider Demographics
NPI:1053437640
Name:ALEJANDRO M. ARREDONDO O.D. OPT. CORP.
Entity type:Organization
Organization Name:ALEJANDRO M. ARREDONDO O.D. OPT. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-583-7900
Mailing Address - Street 1:4349 SLAUSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-2837
Mailing Address - Country:US
Mailing Address - Phone:323-581-0117
Mailing Address - Fax:323-562-4445
Practice Address - Street 1:2675 SATURN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4142
Practice Address - Country:US
Practice Address - Phone:323-581-0117
Practice Address - Fax:323-562-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8658T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0086581Medicaid
CASD0086582Medicaid
CAU38001Medicare UPIN
CADW105ZMedicare PIN
CADW224AMedicare PIN