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General NPI Number Information
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NPI Number | 1831743525
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Entity Type | Organization
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Legal Business Name | PV VISION
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 4250 VAN BUREN BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92503-2602
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Country | US
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Telephone | 213-500-8292
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Fax |
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Provider Business Mailing Address
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Address Line | 23684 GOLD NUGGET AVE
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2335
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Country | US
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Telephone | 213-500-8292
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONG EOK SHIN
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Credential |
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Telephone | 213-500-8292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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