Healthcare Provider Details

I. General information

NPI: 1508420290
Provider Name (Legal Business Name): GENE S. MAH, O.D., AN OPTOMETRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14501 LAKEWOOD BLVD
PARAMOUNT CA
90723-3601
US

IV. Provider business mailing address

14501 LAKEWOOD BLVD
PARAMOUNT CA
90723-3601
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-2717
  • Fax:
Mailing address:
  • Phone: 562-602-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GENE S MAH
Title or Position: OPTOMETRIST
Credential: OD
Phone: 562-602-2717