Healthcare Provider Details

I. General information

NPI: 1881504876
Provider Name (Legal Business Name): LOMA LINDA OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25815 BARTON RD STE C104
LOMA LINDA CA
92354-3893
US

IV. Provider business mailing address

25815 BARTON RD STE C104
LOMA LINDA CA
92354-3893
US

V. Phone/Fax

Practice location:
  • Phone: 909-478-3345
  • Fax: 909-478-9337
Mailing address:
  • Phone: 909-478-3345
  • Fax: 909-478-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DOUGLAS KEVIN SODERBLOM
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 909-478-3345