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General NPI Number Information
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NPI Number | 1003683855
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Entity Type | Organization
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Legal Business Name | OPTO BAR OPTOMETRIC INC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 8022 MELROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90046
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Country | US
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Telephone | 714-717-4035
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Fax |
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Provider Business Mailing Address
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Address Line | 5071 AUDREY DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2402
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Country | US
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Telephone | 714-717-4035
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LILAN LE
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Credential | OD
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Telephone | 714-717-4035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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