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General NPI Number Information
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NPI Number | 1043317068
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Entity Type | Organization
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Legal Business Name | EYE MAX OPTOMETRY WILSHIRE, INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 3359 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-1803
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Country | US
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Telephone | 213-382-2777
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Fax | 213-382-6777
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Provider Business Mailing Address
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Address Line | 3359 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-1803
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Country | US
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Telephone | 213-382-2777
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Fax | 213-382-6777
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIN SUK-KYUNG HAN
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Credential | O.D.
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Telephone | 213-382-2777
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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 | 8482T
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License Number State | CA
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