Healthcare Provider Details

I. General information

NPI: 1669892188
Provider Name (Legal Business Name): LEUNG, MARSDEN, AND WALD, A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 COCHRAN ST SUITE D
SIMI VALLEY CA
93065-2796
US

IV. Provider business mailing address

2845 COCHRAN ST SUITE D
SIMI VALLEY CA
93065-2796
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-6824
  • Fax: 805-527-9247
Mailing address:
  • Phone: 805-527-6824
  • Fax: 805-527-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAYSY LIRA
Title or Position: BILLING
Credential:
Phone: 805-527-6824