Healthcare Provider Details

I. General information

NPI: 1093795544
Provider Name (Legal Business Name): EAP OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6541 E SPRING ST
LONG BEACH CA
90808-4023
US

IV. Provider business mailing address

6541 E SPRING ST
LONG BEACH CA
90808-4023
US

V. Phone/Fax

Practice location:
  • Phone: 562-496-3365
  • Fax: 562-496-2764
Mailing address:
  • Phone: 562-496-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT10107T
License Number StateCA

VIII. Authorized Official

Name: STEPHEN HOR-BENG EAP
Title or Position: PRESIDENT
Credential: O.D., J.D.
Phone: 562-496-3365