Healthcare Provider Details

I. General information

NPI: 1154249878
Provider Name (Legal Business Name): EB PROFESSIONAL SERVICES OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S VERMONT AVE
LOS ANGELES CA
90004-5906
US

IV. Provider business mailing address

219 S VERMONT AVE
LOS ANGELES CA
90004-5906
US

V. Phone/Fax

Practice location:
  • Phone: 626-817-2817
  • Fax: 213-366-6170
Mailing address:
  • Phone: 626-817-2817
  • Fax: 213-366-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DICKSON CHEN
Title or Position: OD/OWNER
Credential: OD
Phone: 626-817-2817