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General NPI Number Information
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NPI Number | 1184992281
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Entity Type | Organization
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Legal Business Name | WOODBRIDGE OPTOMETRY
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 4040 BARRANCA PKWY SUITE 110
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City | IRVINE
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State | CA
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Zip | 92604-4766
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Country | US
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Telephone | 949-857-0676
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Fax | 949-857-2175
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Provider Business Mailing Address
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Address Line | 4040 BARRANCA PARKWAY SUITE 110
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City | IRVINE
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State | CA
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Zip | 92604-4772
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Country | US
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Telephone | 949-857-0676
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Fax | 949-857-2175
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER PAUL LIKENS
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Credential | O.D.
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Telephone | 949-857-0676
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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 | 8038T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14184T
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8049T
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7839T
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License Number State | CA
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