Healthcare Provider Details

I. General information

NPI: 1164195400
Provider Name (Legal Business Name): PUJA PAREKH O D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S IDAHO ST STE H
LA HABRA CA
90631-0607
US

IV. Provider business mailing address

18299 GOLDBARK WAY
YORBA LINDA CA
92886-8424
US

V. Phone/Fax

Practice location:
  • Phone: 562-316-0216
  • Fax:
Mailing address:
  • Phone: 909-717-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PUJA PAREKH
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 909-717-6971