Healthcare Provider Details

I. General information

NPI: 1780136077
Provider Name (Legal Business Name): INTELLIGENT EYE CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7232 ROSEMEAD BLVD STE 202
SAN GABRIEL CA
91775-1389
US

IV. Provider business mailing address

PO BOX 396
TEMPLE CITY CA
91780-0396
US

V. Phone/Fax

Practice location:
  • Phone: 626-534-6698
  • Fax:
Mailing address:
  • Phone: 626-534-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number135726
License Number StateCA

VIII. Authorized Official

Name: DIANA CHAO
Title or Position: OWNER
Credential:
Phone: 626-203-8298