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General NPI Number Information
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NPI Number | 1235351313
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Entity Type | Organization
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Legal Business Name | FAMILY OPTOMETRY OF IRVINE
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 3873 PORTOLA PKWY
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City | IRVINE
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State | CA
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Zip | 92620
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Country | US
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Telephone | 714-730-2020
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Fax | 714-730-2023
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Provider Business Mailing Address
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Address Line | 3873 PORTOLA PKWY
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City | IRVINE
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State | CA
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Zip | 92620
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Country | US
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Telephone | 714-730-2020
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Fax | 714-730-2023
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | DR. SUSAN KIM LEE
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Credential | O.D.
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Telephone | 714-661-9834
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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 | 10993T
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License Number State | CA
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