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General NPI Number Information
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NPI Number | 1477372605
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Entity Type | Organization
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Legal Business Name | IMPERIAL VALLEY OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 3450 KURTZ ST STE D
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City | SAN DIEGO
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State | CA
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Zip | 92110-4451
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Country | US
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Telephone | 619-291-4810
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 KURTZ ST STE D
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City | SAN DIEGO
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State | CA
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Zip | 92110-4451
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Country | US
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Telephone | 619-291-4810
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Fax |
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Authorized Official
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Title or Position | PRACTICE RELATIONS MANAGER
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Name | KRISTEN YOUNG
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Credential |
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Telephone | 309-416-0857
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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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