Healthcare Provider Details

I. General information

NPI: 1306430384
Provider Name (Legal Business Name): HORIZON OPTOMETRY GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14361 BEACH BLVD STE 201
WESTMINSTER CA
92683-8140
US

IV. Provider business mailing address

14361 BEACH BLVD STE 201
WESTMINSTER CA
92683-8140
US

V. Phone/Fax

Practice location:
  • Phone: 714-775-0019
  • Fax: 714-775-0026
Mailing address:
  • Phone: 714-684-1711
  • Fax: 714-775-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLEE L TEA LE
Title or Position: SECRETARY
Credential: OD
Phone: 714-775-7045