Healthcare Provider Details

I. General information

NPI: 1982731402
Provider Name (Legal Business Name): NEW LOOK FAMILY OPTOMETRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121.5 W. WILSON AVE.
GLENDALE CA
91203
US

IV. Provider business mailing address

121.5 W. WILSON AVE.
GLENDALE CA
91203
US

V. Phone/Fax

Practice location:
  • Phone: 818-507-6100
  • Fax:
Mailing address:
  • Phone: 818-507-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12725-T
License Number StateCA

VIII. Authorized Official

Name: DR. PHU-SCOTT VI LAM
Title or Position: OWNER, PRESIDENT
Credential: O.D.
Phone: 818-507-6100