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General NPI Number Information
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NPI Number | 1861189011
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Entity Type | Organization
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Legal Business Name | DR. MIMIA WEN OPTOMETRY PC
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 2651 IRVINE AVE STE 120
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City | COSTA MESA
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State | CA
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Zip | 92627-6620
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Country | US
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Telephone | 949-439-8471
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Fax |
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Provider Business Mailing Address
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Address Line | 2651 IRVINE AVE STE 120
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City | COSTA MESA
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State | CA
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Zip | 92627-6620
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Country | US
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Telephone | 949-432-7894
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Fax | 949-432-7880
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Authorized Official
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Title or Position | PRESIDENT/AUTHORIZED OFFICIAL
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Name | DR. MIMIA WEN
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Credential | OD
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Telephone | 949-432-7894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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