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General NPI Number Information
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NPI Number | 1144696592
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Entity Type | Organization
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Legal Business Name | VISION INSTITUTE OF SOUTHERN CALIFORNIA A PROFESSIONAL MEDICAL CORPORA
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 375 HUNTINGTON DR. STE. D
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City | SAN MARINO
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State | CA
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Zip | 91108
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Country | US
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Telephone | 626-389-2920
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Fax | 626-389-2921
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Provider Business Mailing Address
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Address Line | 18725 GALE AVENUE SUITE 140
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91748
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Country | US
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Telephone | 626-854-2020
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Fax | 626-854-2021
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Authorized Official
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Title or Position | MEDICAL DIRECTOR & EYE SURGEON
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Name | ROBERT LIN
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Credential | M.D.
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Telephone | 626-854-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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