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General NPI Number Information
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NPI Number | 1194430074
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Entity Type | Organization
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Legal Business Name | ANNESSA DU, O.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/29/2023
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Provider Practice Location Address
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Address Line | 11346 MOUNTAIN VIEW AVE STE B
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City | LOMA LINDA
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State | CA
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Zip | 92354-3833
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Country | US
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Telephone | 909-796-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 11030 GARVEY AVE
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City | EL MONTE
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State | CA
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Zip | 91733-2463
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Country | US
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Telephone | 626-696-6961
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. ANNESSA DU
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Credential | OD
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Telephone | 626-696-6961
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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 |
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License Number State |
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