Healthcare Provider Details

I. General information

NPI: 1881735009
Provider Name (Legal Business Name): EDWARD SOON LOUIE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FREMONT HUB COURTYARD
FREMONT CA
94538-7701
US

IV. Provider business mailing address

101 FREMONT HUB COURTYARD
FREMONT CA
94538-7701
US

V. Phone/Fax

Practice location:
  • Phone: 510-791-8228
  • Fax:
Mailing address:
  • Phone: 510-791-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7986T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: