Healthcare Provider Details

I. General information

NPI: 1023248853
Provider Name (Legal Business Name): REGINA SEEN WON GARRIOTT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 YORBA LINDA BLVD
FULLERTON CA
92831-1615
US

IV. Provider business mailing address

2575 YORBA LINDA BLVD
FULLERTON CA
92831-1615
US

V. Phone/Fax

Practice location:
  • Phone: 714-992-7870
  • Fax: 714-992-7871
Mailing address:
  • Phone: 714-992-7870
  • Fax: 714-992-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9937TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: