Healthcare Provider Details

I. General information

NPI: 1346961356
Provider Name (Legal Business Name): MONICA LUONG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 STORY RD STE 1079
SAN JOSE CA
95122-2670
US

IV. Provider business mailing address

7095 MARKET PLACE DR
GOLETA CA
93117-5905
US

V. Phone/Fax

Practice location:
  • Phone: 408-886-4803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: