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General NPI Number Information
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NPI Number | 1184809246
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Entity Type | Organization
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Legal Business Name | EYE INSTITUTE OF LOS ANGELES
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 01/12/2008
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Provider Practice Location Address
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Address Line | 420 N GARFIELD AVE STE 208
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City | MONTEREY PARK
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State | CA
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Zip | 91754-1206
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Country | US
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Telephone | 626-572-3937
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Fax | 626-571-8847
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Provider Business Mailing Address
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Address Line | 420 N GARFIELD AVE STE 208
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City | MONTEREY PARK
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State | CA
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Zip | 91754-1206
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Country | US
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Telephone | 626-572-3937
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Fax | 626-571-8847
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TIN CHEU WONG
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Credential | M.D.
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Telephone | 626-572-3937
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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 | G56514
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License Number State | CA
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