MEDICARE: BRIGHT VISION OPTOMETRY

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	14005	CA
2	152W00000X	Optometrist	14716	CA

General Provider Information

NPI Number	:	1972971901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT VISION OPTOMETRY

Provider Business Mailing Address
First Line	:	2935 CHINO AVE
Second Line	:	SUITE E3
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3575
Country	:	US
Telephone Number	:	909-627-1111
Fax Number	:	909-627-1112

Provider Business Practice Location Address
First Line	:	2935 CHINO AVE
Second Line	:	SUITE E3
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3575
Country	:	US
Telephone Number	:	909-627-1111
Fax Number	:	909-627-1112

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	STEVEN SOONG
Credential	:	O.D.
Telephone Number	:	626-430-8085

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	09/08/2015

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Directions to “BRIGHT VISION OPTOMETRY ” Practice Location

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