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General NPI Number Information
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NPI Number | 1871746982
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Entity Type | Organization
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Legal Business Name | MIKA E FU O D INC A CALIFORNIA PROFESSIONAL OPTOMETRIC CORPORATIO
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 151 S LAS POSAS RD STE 171
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City | SAN MARCOS
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State | CA
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Zip | 92078-2471
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Country | US
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Telephone | 760-510-3130
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Fax | 760-510-3131
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Provider Business Mailing Address
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Address Line | 151 S LAS POSAS RD STE 171
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City | SAN MARCOS
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State | CA
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Zip | 92078-2471
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Country | US
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Telephone | 760-510-3130
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Fax | 760-510-3131
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIKA E FU
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Credential | O.D.
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Telephone | 760-510-3130
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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 | OPT13304T
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License Number State | CA
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