Healthcare Provider Details

I. General information

NPI: 1548695554
Provider Name (Legal Business Name): PEK Y. LOU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILY LOU

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 E HERNDON AVE SUITE 301
FRESNO CA
93720-3326
US

IV. Provider business mailing address

1360 E HERNDON AVE SUITE 301
FRESNO CA
93720-3326
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-5000
  • Fax: 559-439-7854
Mailing address:
  • Phone: 559-486-5000
  • Fax: 559-439-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002868
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 15070
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT15040TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: