MEDICARE: DR. SANDIA JEN OU O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12911 T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578516977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDIA JEN OU O.D.

Provider Business Mailing Address
First Line	:	25 E HUNTINGTON DR
Second Line	:	SUITE #111
City	:	ARCADIA
State	:	CA
Zip	:	91006-3210
Country	:	US
Telephone Number	:	626-393-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E HUNTINGTON DR
Second Line	:	SUITE #111
City	:	ARCADIA
State	:	CA
Zip	:	91006-3210
Country	:	US
Telephone Number	:	626-393-8885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/14/2010

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