1497275440 NPI number — 2 SEE OPTOMETRY

Table of content: (NPI 1497275440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497275440 NPI number — 2 SEE OPTOMETRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
2 SEE OPTOMETRY
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:
1497275440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5060 ANGELES CREST HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CANADA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91011-2368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-790-5670
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3115 FOOTHILL BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CRESCENTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91214-4237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-832-4646
Provider Business Practice Location Address Fax Number:
818-368-9898
Provider Enumeration Date:
06/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HAN
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
JUNGHYE
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
818-832-4646

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  11143T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SD0111430 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com