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General NPI Number Information
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NPI Number | 1437278728
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Entity Type | Organization
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Legal Business Name | ILY OPTOMETRY, INC.
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 100 NEWPARK MALL
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City | NEWARK
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State | CA
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Zip | 94560-5252
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Country | US
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Telephone | 510-745-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 4675 AMIENS AVE
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City | FREMONT
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State | CA
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Zip | 94555-2519
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Country | US
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Telephone | 301-801-5799
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD LY
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Credential | O.D.
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Telephone | 301-801-5799
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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 | 13673T
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License Number State | CA
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