Healthcare Provider Details

I. General information

NPI: 1932884731
Provider Name (Legal Business Name): WYSE WILLA OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 W DUARTE RD STE 10
ARCADIA CA
91007-7619
US

IV. Provider business mailing address

638 W DUARTE RD STE 10
ARCADIA CA
91007-7619
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-1186
  • Fax: 626-445-1452
Mailing address:
  • Phone: 626-445-1186
  • Fax: 626-445-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WENDY YVETTE MAY SHEM
Title or Position: CEO
Credential: OD
Phone: 626-445-1186