1376660886 NPI number — FASHION OPTICAL CORPORATION

Table of content: (NPI 1376660886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376660886 NPI number — FASHION OPTICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FASHION OPTICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376660886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 S GOLDEN WEST AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ARCADIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91007-7484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-821-0222
Provider Business Mailing Address Fax Number:
626-821-9420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 S GOLDEN WEST AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91007-7484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-821-0222
Provider Business Practice Location Address Fax Number:
626-821-9420
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-821-0222

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  D4201 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332H00000X , with the licence number: D4201 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DX004201F . This is a "MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 09310 . This is a "MEDICAL EYE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 51046 . This is a "DAVIS VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FO20092 . This is a "SPECTERA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA4201 . This is a "EYEMED VISIONCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 58119 . This is a "SAFEGUARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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