| NPI | 1144958448 |
|---|---|
| Doing Business As | GRAND LAKE OPTOMETRY |
| Entity Type | Organization |
| Authorized Contact | ANGELA CHEUNG Owner 510-832-3162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2022-08-13 |
| Last Update Date | 2022-08-13 |