Express Lens Lab, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

19209 Issued in CA

Legal business name

EXPRESS LENS LAB, INC.

Practice address

17150 Newhope St
Suite 305
Fountain Valley, CA 92708-4250

Phone

(714) 545-1024

Fax

(714) 556-2026

NPI assigned

Dec 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brian Keith GoldstoneNPI 1437612850

Title

President

Phone

(714) 545-1024

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian Goldstone, ABOC

  • Optician
  • Fountain Valley, CA
  • NPI 1437612850
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164588133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17150 NEWHOPE ST",
            "address_2": "SUITE 305",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084250",
            "telephone_number": "714-545-1024",
            "fax_number": "714-556-2026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17150 NEWHOPE ST",
            "address_2": "SUITE 305",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084250",
            "telephone_number": "714-545-1024",
            "fax_number": "714-556-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPRESS LENS LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOLDSTONE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-545-1024",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "19209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "772534",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "88272567",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia A. Evans, CNM
• Robin Evanson, FNP-BC
• Evelyn Llorente MD Inc
• Exclusive Professional Services, Inc.
• Exomed, Inc.
• Eye to Eye Optometry
• Ashley Christina Fagan
• Alisa Falbo
• Julie S Fallon, MD
• Families Together of Orange County

• Eyewear Supplier in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Eyewear Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.