=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770865735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION INSTITUTE OF SOUTHERN CALIFORNIA A PROFESSIONAL MEDICAL CORPORA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2011
-----------------------------------------------------
Last Update Date | 12/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18725 GALE AVE STE 140
-----------------------------------------------------
City | CITY OF INDUSTRY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91748-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-854-2020
-----------------------------------------------------
Fax | 626-854-2021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18725 GALE AVE STE 140
-----------------------------------------------------
City | CITY OF INDUSTRY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91748-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-854-2020
-----------------------------------------------------
Fax | 626-854-2021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT TING-CHAY LIN
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 626-854-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number | 207W00000X
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------