MEDICARE: VISUAL SPECTRUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	D 7058	CA

General Provider Information

NPI Number	:	1609099498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISUAL SPECTRUM

Provider Business Mailing Address
First Line	:	1036 S GRANDRIDGE AVE
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-4936
Country	:	US
Telephone Number	:	626-573-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1103 FAIR OAKS AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3311
Country	:	US
Telephone Number	:	626-441-0770
Fax Number	:	626-441-0990

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PING GUAN
Credential	:	ABO
Telephone Number	:	626-825-8197

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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