Healthcare Provider Details

I. General information

NPI: 1154287613
Provider Name (Legal Business Name): ANTIOCH OPTOMETRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 VERNE ROBERTS CIR
ANTIOCH CA
94509-7911
US

IV. Provider business mailing address

2201 VERNE ROBERTS CIR
ANTIOCH CA
94509-7911
US

V. Phone/Fax

Practice location:
  • Phone: 925-470-4616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ALLEN LUONG
Title or Position: OWNER
Credential: OD
Phone: 510-828-8643