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General NPI Number Information
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NPI Number | 1528188448
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Entity Type | Organization
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Legal Business Name | COVINA EYECARE OPTOMETRY INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 911 N GRAND AVE
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City | COVINA
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State | CA
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Zip | 91724-2046
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Country | US
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Telephone | 626-967-3794
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Fax | 626-967-8404
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Provider Business Mailing Address
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Address Line | 911 N GRAND AVE
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City | COVINA
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State | CA
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Zip | 91724-2046
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Country | US
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Telephone | 626-967-3794
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Fax | 626-967-8404
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWIN WU
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Credential | OD
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Telephone | 626-967-3794
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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 | OPT 13985 TPG
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License Number State | CA
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