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General NPI Number Information
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NPI Number | 1316473283
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Entity Type | Organization
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Legal Business Name | EYEWEAR 88 STUDIO INC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 113 LOS CERRITOS MALL
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City | CERRITOS
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State | CA
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Zip | 90703-5420
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Country | US
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Telephone | 562-567-8489
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Fax |
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Provider Business Mailing Address
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Address Line | 113 LOS CERRITOS MALL
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City | CERRITOS
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State | CA
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Zip | 90703-5420
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Country | US
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Telephone | 562-567-8489
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | DERRICK TRAN
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Credential |
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Telephone | 562-377-7288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | D70740
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License Number State | CA
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