Healthcare Provider Details

I. General information

NPI: 1124509138
Provider Name (Legal Business Name): ING OPTICAL,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14251 JEFFREY RD
IRVINE CA
92620-3405
US

IV. Provider business mailing address

14251 JEFFREY RD
IRVINE CA
92620-3405
US

V. Phone/Fax

Practice location:
  • Phone: 949-559-1234
  • Fax:
Mailing address:
  • Phone: 949-559-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JIN CHO
Title or Position: CEO
Credential:
Phone: 949-559-1234