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General NPI Number Information
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NPI Number | 1578020376
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Entity Type | Organization
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Legal Business Name | ARDEN OPTOMETRIC ASSOCIATES
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 1689 ARDEN WAY STE 1344
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City | SACRAMENTO
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State | CA
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Zip | 95815-4099
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Country | US
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Telephone | 916-922-6584
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 HARDING TER
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City | DAVIS
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State | CA
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Zip | 95616-3057
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Country | US
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Telephone | 323-899-0196
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ARIE WONG
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Credential | OD
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Telephone | 323-899-0196
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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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