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General NPI Number Information
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NPI Number | 1033517008
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC ALLIANCE INC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 2360 HUNTINGTON DR #200
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City | SAN MARINO
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State | CA
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Zip | 91108-2656
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Country | US
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Telephone | 626-737-7319
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Fax |
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Provider Business Mailing Address
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Address Line | 2360 HUNTINGTON DR #210
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City | SAN MARINO
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State | CA
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Zip | 91108-2656
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Country | US
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Telephone | 626-737-7319
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JUDY LIAO
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Credential | O.D.
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Telephone | 626-737-7319
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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 | 11694
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License Number State | CA
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