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General NPI Number Information
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NPI Number | 1689944217
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Entity Type | Organization
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Legal Business Name | UTOPIA OPTOMETRY
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 03/02/2014
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Provider Practice Location Address
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Address Line | 1552 FOOTHILL BLVD
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City | LA VERNE
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State | CA
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Zip | 91750-3434
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Country | US
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Telephone | 909-593-4423
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Fax | 909-593-0176
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Provider Business Mailing Address
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Address Line | 1552 FOOTHILL BLVD
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City | LA VERNE
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State | CA
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Zip | 91750-3434
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Country | US
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Telephone | 909-593-4423
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Fax | 909-593-0176
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Authorized Official
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Title or Position | CFO
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Name | DR. TIM C LIU
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Credential | O.D.
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Telephone | 909-593-4423
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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 | 13573
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License Number State | CA
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