Healthcare Provider Details

I. General information

NPI: 1770203283
Provider Name (Legal Business Name): WYSE WILLA OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 E WALNUT ST
PASADENA CA
91106-1528
US

IV. Provider business mailing address

1368 E WALNUT ST
PASADENA CA
91106-1528
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-3105
  • Fax: 626-796-8816
Mailing address:
  • Phone: 626-796-3105
  • Fax: 626-796-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. WENDY SHEM YEH
Title or Position: OWNER
Credential: OD
Phone: 626-796-3105