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General NPI Number Information
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NPI Number | 1851785141
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Entity Type | Organization
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Legal Business Name | DOWNEY VISION OPTOMETRY, INC.
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 10353 LAKEWOOD BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-2743
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Country | US
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Telephone | 562-923-5501
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Fax | 562-923-8863
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Provider Business Mailing Address
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Address Line | 10353 LAKEWOOD BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-2743
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Country | US
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Telephone | 562-923-5501
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Fax | 562-923-8863
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNY QUYEN B TIET
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Credential | O.D.
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Telephone | 714-600-7017
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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 | OPT 11489 TPL
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License Number State | CA
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