Basic Information
| Provider Information | |||||||||
| NPI: | 1588200406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CVS AOC CORPORATION | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | OPTICAL CENTER INSIDE CVS PHARMACY STORE 9692 | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CVS DRIVE | ||||||||
| Address2: | MAILSTOP #3005 | ||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028956146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0147702286 | ||||||||
| FaxNumber: | 0142694731 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 W VERDUGO AVE | ||||||||
| Address2: | STORE # 9692 | ||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915062150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472617747 | ||||||||
| FaxNumber: | 8188411015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2019 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEA | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR MANAGER, CVS OPTICAL | ||||||||
| AuthorizedOfficialTelephone: | 4013742519 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CVS PHARMACY, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.