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General NPI Number Information
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NPI Number | 1871921916
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Entity Type | Organization
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Legal Business Name | EYE RX, AN OPTOMETRIC GROUP
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 8450 LA PALMA AVE
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City | BUENA PARK
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State | CA
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Zip | 90620-3210
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Country | US
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Telephone | 714-527-9236
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Fax | 714-527-5873
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Provider Business Mailing Address
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Address Line | 8450 LA PALMA AVE
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City | BUENA PARK
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State | CA
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Zip | 90620-3210
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Country | US
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Telephone | 626-222-1243
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Fax | 714-527-5873
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID WONG
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Credential | OD
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Telephone | 626-222-1243
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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 | 13211
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License Number State | CA
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