Healthcare Provider Details

I. General information

NPI: 1124468236
Provider Name (Legal Business Name): PUENTE HILLS OPTOMETRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 PLAZA DR
WEST COVINA CA
91790-2842
US

IV. Provider business mailing address

2036 PLAZA DR
WEST COVINA CA
91790-2842
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-5537
  • Fax:
Mailing address:
  • Phone: 626-960-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIPAK PATEL
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 626-960-5537