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General NPI Number Information
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NPI Number | 1467074989
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Entity Type | Organization
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Legal Business Name | IKONIC VISION CARE, INC.
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 855 E BIRCH ST
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City | BREA
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State | CA
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Zip | 92821-5769
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Country | US
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Telephone | 714-989-5019
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Fax | 714-255-2010
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Provider Business Mailing Address
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Address Line | 855 E BIRCH ST
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City | BREA
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State | CA
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Zip | 92821-5769
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Country | US
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Telephone | 714-989-5019
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Fax | 714-255-2010
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Authorized Official
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Title or Position | CEO
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Name | DR. YANNA YU
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Credential | OD
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Telephone | 714-989-5019
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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 |
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License Number State |
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