| NPI | 1306430384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEE L TEA LE Secretary 714-775-7045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2021-02-22 |