Healthcare Provider Details

I. General information

NPI: 1336789296
Provider Name (Legal Business Name): DIAMOND VISION OPTOMETRY ASSOCIATES AND GTC OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S LAKE AVE STE 111
PASADENA CA
91101-3553
US

IV. Provider business mailing address

350 S LAKE AVE STE 111
PASADENA CA
91101-3553
US

V. Phone/Fax

Practice location:
  • Phone: 626-683-6868
  • Fax: 626-782-6162
Mailing address:
  • Phone: 626-683-6868
  • Fax: 626-782-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. GRACE TRAN CHI
Title or Position: OPTOMETRIST
Credential: OD
Phone: 626-683-6868