| NPI | 1548634504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA DUONG CEO/O PT Ometrist 909-225-7499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14233TLG) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA 14233TLG) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: CA 14233TLG) | |
| 152WP0200X Optometrist Pediatrics (Licence: CA 14233TLG) | |
| 152WS0006X Optometrist Sports Vision (Licence: CA 14233TLG) | |
| 152WV0400X Optometrist Vision Therapy (Licence: CA 14233TLG) | |
| 152WX0102X Optometrist Occupational Vision (Licence: CA 14233TLG) | |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2015-11-13 |