Healthcare Provider Details

I. General information

NPI: 1083436356
Provider Name (Legal Business Name): LOI THANH MAI OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16106 BELLFLOWER BLVD
BELLFLOWER CA
90706-4606
US

IV. Provider business mailing address

1725 E OAKRIDGE CIR
WEST COVINA CA
91792-1939
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-4716
  • Fax:
Mailing address:
  • Phone: 714-724-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LOI THANH MAI
Title or Position: CEO/CFO
Credential: OD
Phone: 714-724-1540