Healthcare Provider Details

I. General information

NPI: 1821461237
Provider Name (Legal Business Name): ALVIN LO OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W FOOTHILL BLVD
AZUSA CA
91702-2819
US

IV. Provider business mailing address

433 OAK KNOLL DR
GLENDORA CA
91741-3013
US

V. Phone/Fax

Practice location:
  • Phone: 626-610-6727
  • Fax:
Mailing address:
  • Phone: 626-610-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number95-447832
License Number StateCA

VIII. Authorized Official

Name: MR. ALVIN KWAN YANG LO
Title or Position: PRESIDENT
Credential: OD
Phone: 626-969-7859