Healthcare Provider Details

I. General information

NPI: 1124271697
Provider Name (Legal Business Name): PARAMOUNT FAMILY VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14905 PARAMOUNT BLVD UNIT # E
PARAMOUNT CA
90723-3440
US

IV. Provider business mailing address

14905 PARAMOUNT BLVD UNIT # E
PARAMOUNT CA
90723-3440
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-6046
  • Fax: 562-633-0260
Mailing address:
  • Phone: 562-633-6046
  • Fax: 562-633-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8777T
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW R LIM
Title or Position: OWNER
Credential: O.D.
Phone: 562-633-6046