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General NPI Number Information
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NPI Number | 1699987073
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Entity Type | Organization
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Legal Business Name | WILLIAM Y S TOM & WESLEY F TOM PTRS
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 942 N BROADWAY SUITE 104
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City | LOS ANGELES
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State | CA
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Zip | 90012-1707
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Country | US
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Telephone | 213-680-9393
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Fax | 213-680-2921
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Provider Business Mailing Address
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Address Line | 942 N BROADWAY SUITE 104
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City | LOS ANGELES
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State | CA
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Zip | 90012-1707
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Country | US
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Telephone | 213-680-9393
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Fax | 213-680-2921
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. WESLEY FONG TOM
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Credential | OD
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Telephone | 213-680-9393
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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 | 9469T
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License Number State | CA
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