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General NPI Number Information
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NPI Number | 1366781650
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Entity Type | Organization
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Legal Business Name | COLIMA OPTOMETRY INC
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 1758 SIERRA LEONE AVE SUITE A
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City | ROWLAND HGHTS
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State | CA
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Zip | 91748-5837
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Country | US
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Telephone | 626-839-2938
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Fax | 951-652-0050
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Provider Business Mailing Address
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Address Line | 208 N LINCOLN AVE APT. 109
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City | MONTEREY PARK
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State | CA
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Zip | 91755-1719
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Country | US
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Telephone | 917-723-6462
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Fax | 951-652-0050
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVE PENN
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Credential | O.D.
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Telephone | 951-652-8738
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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 | 13661
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License Number State | CA
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