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General NPI Number Information
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NPI Number | 1194027748
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Entity Type | Organization
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Legal Business Name | DIAMOND VISION OPTOMETRY INC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 350 S LAKE AVE #111
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City | PASADENA
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State | CA
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Zip | 91101-3530
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Country | US
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Telephone | 626-683-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 350 S LAKE AVE #111
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City | PASADENA
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State | CA
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Zip | 91101-3530
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Country | US
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Telephone | 626-683-6868
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILBUR WU
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Credential | OD
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Telephone | 626-683-6868
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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 | 13593
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License Number State | CA
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