Healthcare Provider Details

I. General information

NPI: 1710339114
Provider Name (Legal Business Name): PETER TIEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W DUARTE RD STE 101
ARCADIA CA
91007-9266
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-9010
  • Fax: 626-254-9019
Mailing address:
  • Phone: 310-301-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: