=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346356987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGNOLIA EYE CARE MEDICAL CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 09/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14571 MAGNOLIA ST #205
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-5574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-894-4599
-----------------------------------------------------
Fax | 714-897-7367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14571 MAGNOLIA ST #205
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-5574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-894-4599
-----------------------------------------------------
Fax | 714-897-7367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DR. ARTHUR LU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-894-4599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------