Icon Optical Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

27748407 Issued in CA

Legal business name

ICON OPTICAL INC

Doing business as

1001 OPTICAL

Practice address

2880 W Olympic Blvd Ste 101
Los Angeles, CA 90006-2644

Phone

(213) 385-3388

Fax

(213) 385-3328

NPI assigned

May 24, 2013

Organization subpart

No

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

Authorized official

Name

Byungsoo Chae

Title

Owner

Phone

(213) 385-3388

Specialties & licenses 1

Addresses

Other names 1

• 1001 OPTICAL Doing business as

Locations

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

{
    "created_epoch": "1369353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369353600000",
    "number": "1467899880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2880 W OLYMPIC BLVD STE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062644",
            "telephone_number": "213-385-3388",
            "fax_number": "213-385-3328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 W OLYMPIC BLVD STE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062644",
            "telephone_number": "213-385-3388",
            "fax_number": "213-385-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICON OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-24",
        "last_updated": "2013-05-24",
        "status": "A",
        "authorized_official_last_name": "CHAE",
        "authorized_official_first_name": "BYUNGSOO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "213-385-3388"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "27748407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "1001 OPTICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anne Marie Ichiuji, MD
• Brynne Ariye Ichiuji
• Mary M. Ichiuji, MD
• Trisha Leilani Ichiyama, LMT
• Jason Ickovitz, LMFT
• Doris J Icute
• Ida Ganapolsky, D.D.S. a Professional Dental Corp.
• Ida Transportation LLC
• Erica Ide, M.A.
• Nobuko Ide, LA.C

• Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; 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.