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General NPI Number Information
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NPI Number | 1518339530
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Entity Type | Organization
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Legal Business Name | LUM OPTOMETRY INC
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 2561 EL CAMINO REAL
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City | CARLSBAD
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State | CA
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Zip | 92008-1202
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Country | US
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Telephone | 760-730-7320
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Fax | 760-729-5169
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Provider Business Mailing Address
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Address Line | 8940 FLANDERS DR
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City | SAN DIEGO
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State | CA
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Zip | 92126-2825
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Country | US
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Telephone | 619-655-0313
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN LUM
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Credential | O.D.
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Telephone | 619-655-0313
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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 | 12485
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License Number State | CA
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