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General NPI Number Information
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NPI Number | 1316474547
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Entity Type | Organization
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Legal Business Name | K & L OPTOMETRIC GROUP INC
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Dates
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Enumeration Date | 05/18/2017
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Last Update Date | 05/18/2017
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Provider Practice Location Address
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Address Line | 1301 S LONE HILL AVE
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City | GLENDORA
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State | CA
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Zip | 91740-5348
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Country | US
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Telephone | 909-394-7759
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 SOLANO CIR
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City | MONTEBELLO
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State | CA
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Zip | 90640-3236
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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 | VICE PRESIDENT
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Name | LIMM LAM
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Credential | OD
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Telephone | 323-484-4564
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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 | 14843TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14735TLG
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License Number State | CA
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