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General NPI Number Information
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NPI Number | 1073563706
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Entity Type | Organization
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Legal Business Name | ANTELOPE VALLEY FAMILY OPTOMETRY, INC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 2720 E PALMDALE BLVD STE 133
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City | PALMDALE
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State | CA
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Zip | 93550-4930
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Country | US
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Telephone | 661-267-0026
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Fax | 661-267-0892
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Provider Business Mailing Address
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Address Line | 2720 E PALMDALE BLVD SUITE 133
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City | PALMDALE
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State | CA
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Zip | 93550-4930
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Country | US
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Telephone | 661-267-0026
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Fax | 661-267-0892
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL LIN
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Credential | O.D.
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Telephone | 661-267-0026
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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 | 11428T
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License Number State | CA
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