Healthcare Provider Details

I. General information

NPI: 1811390610
Provider Name (Legal Business Name): DIAMOND BAR OPTOMETRIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S DIAMOND BAR BLVD
DIAMOND BAR CA
91765-4122
US

IV. Provider business mailing address

1255 S DIAMOND BAR BLVD
DIAMOND BAR CA
91765-4122
US

V. Phone/Fax

Practice location:
  • Phone: 909-861-4999
  • Fax:
Mailing address:
  • Phone: 909-861-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13920TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number13920TLG
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number13920TLG
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number13920TLG
License Number StateCA

VIII. Authorized Official

Name: DR. NATALIE L HOSHI
Title or Position: OPTOMETRIST
Credential: OD
Phone: 909-861-4999