Provider Demographics
NPI:1871921916
Name:EYE RX, AN OPTOMETRIC GROUP
Entity type:Organization
Organization Name:EYE RX, AN OPTOMETRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-222-1243
Mailing Address - Street 1:8450 LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3210
Mailing Address - Country:US
Mailing Address - Phone:626-222-1243
Mailing Address - Fax:714-527-5873
Practice Address - Street 1:8450 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3210
Practice Address - Country:US
Practice Address - Phone:714-527-9236
Practice Address - Fax:714-527-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty