Provider Demographics
NPI:1053775502
Name:ADVANCED ARTIFICIAL EYES
Entity type:Organization
Organization Name:ADVANCED ARTIFICIAL EYES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED OCULARIST, BOARD AP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:STOLPE
Authorized Official - Suffix:
Authorized Official - Credentials:BCO ,BADO
Authorized Official - Phone:818-758-1666
Mailing Address - Street 1:21112 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2103
Mailing Address - Country:US
Mailing Address - Phone:818-758-1666
Mailing Address - Fax:818-758-1786
Practice Address - Street 1:21112 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2103
Practice Address - Country:US
Practice Address - Phone:818-758-1666
Practice Address - Fax:818-758-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6419480001Medicaid
CA6419480001OtherMEDICARE PTAN