Healthcare Provider Details

I. General information

NPI: 1720856461
Provider Name (Legal Business Name): POOJA NAIK O D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12777 VALLEY VIEW ST STE 111
GARDEN GROVE CA
92845-2521
US

IV. Provider business mailing address

12777 VALLEY VIEW ST STE 111
GARDEN GROVE CA
92845-2521
US

V. Phone/Fax

Practice location:
  • Phone: 714-229-1986
  • Fax: 714-229-1994
Mailing address:
  • Phone: 714-229-1986
  • Fax: 714-229-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: POOJA NAIK
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 562-965-8424