Provider Demographics
NPI:1932884731
Name:WYSE WILLA OPTOMETRY, INC.
Entity type:Organization
Organization Name:WYSE WILLA OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:YVETTE MAY
Authorized Official - Last Name:SHEM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-445-1186
Mailing Address - Street 1:638 W DUARTE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7619
Mailing Address - Country:US
Mailing Address - Phone:626-445-1186
Mailing Address - Fax:626-445-1452
Practice Address - Street 1:638 W DUARTE RD STE 10
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7619
Practice Address - Country:US
Practice Address - Phone:626-445-1186
Practice Address - Fax:626-445-1452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYSE WILLA OPTOMETRY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891788634OtherNPI
1144848201OtherNPI
1821050162OtherNPI