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General NPI Number Information
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NPI Number | 1376633206
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Entity Type | Organization
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Legal Business Name | EL MONTE OPTOMETRY INC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 11230 GARVEY AVE SUITE J
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City | EL MONTE
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State | CA
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Zip | 91733-2475
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Country | US
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Telephone | 626-443-8226
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Fax | 626-443-9108
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Provider Business Mailing Address
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Address Line | 11230 GARVEY AVE SUITE J
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City | EL MONTE
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State | CA
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Zip | 91733-2475
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Country | US
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Telephone | 626-443-8226
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Fax | 626-443-9108
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Authorized Official
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Title or Position | CEO
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Name | CECILIA WONG
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Credential | OD
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Telephone | 626-443-8226
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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 | COR 783
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License Number State | CA
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