Healthcare Provider Details

I. General information

NPI: 1376660886
Provider Name (Legal Business Name): FASHION OPTICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S GOLDEN WEST AVE SUITE B
ARCADIA CA
91007-7484
US

IV. Provider business mailing address

1220 S GOLDEN WEST AVE SUITE B
ARCADIA CA
91007-7484
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-0222
  • Fax: 626-821-9420
Mailing address:
  • Phone: 626-821-0222
  • Fax: 626-821-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberD4201
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberD4201
License Number StateCA

VIII. Authorized Official

Name: MR. HARRY LIN
Title or Position: PRESIDENT
Credential:
Phone: 626-821-0222