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General NPI Number Information
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NPI Number | 1912116799
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Entity Type | Organization
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Legal Business Name | I2IOPTOMETRY.COM,INC.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 265 LAGUNA AVE
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2119
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Country | US
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Telephone | 949-494-1892
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Fax | 949-497-2652
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Provider Business Mailing Address
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Address Line | 265 LAGUNA AVE
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2119
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Country | US
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Telephone | 949-494-1892
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Fax | 949-497-2652
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Authorized Official
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Title or Position | OWNER
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Name | DAVID NORMAN CLER
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Credential | OD
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Telephone | 949-494-1892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 9227T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 6884T
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License Number State | CA
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