Healthcare Provider Details

I. General information

NPI: 1427230465
Provider Name (Legal Business Name): ANTELOPE VALLEY FAMILY OPTOMETRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2007
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25172 RYE CANYON RD
VALENCIA CA
91355-3488
US

IV. Provider business mailing address

25172 RYE CANYON ROAD
VALENCIA CA
91355-3488
US

V. Phone/Fax

Practice location:
  • Phone: 661-294-2733
  • Fax: 661-294-2701
Mailing address:
  • Phone: 661-294-2733
  • Fax: 661-294-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11428T
License Number StateCA

VIII. Authorized Official

Name: DR. PAUL LIN
Title or Position: PRESIDENT
Credential:
Phone: 661-294-2733