Healthcare Provider Details

I. General information

NPI: 1255579082
Provider Name (Legal Business Name): YABE OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7843 KEW AVE
RANCHO CUCAMONGA CA
91739-8801
US

IV. Provider business mailing address

7843 KEW AVE
RANCHO CUCAMONGA CA
91739-8801
US

V. Phone/Fax

Practice location:
  • Phone: 909-646-8813
  • Fax: 909-646-8636
Mailing address:
  • Phone: 909-646-8813
  • Fax: 909-646-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13038
License Number StateCA

VIII. Authorized Official

Name: DR. LEANNE J LAU
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 909-646-8813