=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669892188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEUNG, MARSDEN, AND WALD, A PROFESSIONAL OPTOMETRIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2014
-----------------------------------------------------
Last Update Date | 04/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2845 COCHRAN ST SUITE D
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-2796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-527-6824
-----------------------------------------------------
Fax | 805-527-9247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2845 COCHRAN ST SUITE D
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-2796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-527-6824
-----------------------------------------------------
Fax | 805-527-9247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING
-----------------------------------------------------
Name | MRS. DAYSY LIRA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-527-6824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------