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General NPI Number Information
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NPI Number | 1487194916
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Entity Type | Organization
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Legal Business Name | EYE GEEKS DOCTORS OF OPTOMETRY
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 1001 S BROADWAY STE F
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City | LOS ANGELES
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State | CA
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Zip | 90015-4034
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Country | US
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Telephone | 323-736-2478
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CAMPANITA CT
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City | MONTEREY PARK
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State | CA
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Zip | 91754-2330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. IRENE DIEP
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Credential | O.D.
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Telephone | 323-736-2478
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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 | 13166
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License Number State | CA
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