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General NPI Number Information
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NPI Number | 1275832990
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Entity Type | Organization
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Legal Business Name | CENTURY PARK OPTOMETRY APC
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 3471 W CENTURY BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90303-1218
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Country | US
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Telephone | 310-330-0180
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Fax |
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Provider Business Mailing Address
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Address Line | 8118 ARTSON ST
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City | ROSEMEAD
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State | CA
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Zip | 91770-2524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | KAREN SUN
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Credential |
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Telephone | 626-429-9285
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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 | 13509TLG
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License Number State | CA
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