Provider Demographics
NPI:1023207594
Name:ENVUE OPTOMETRY, INC.
Entity Type:Organization
Organization Name:ENVUE OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:SZETO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-280-6212
Mailing Address - Street 1:8450 VALLEY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1680
Mailing Address - Country:US
Mailing Address - Phone:626-280-6212
Mailing Address - Fax:626-280-6325
Practice Address - Street 1:8450 VALLEY BLVD
Practice Address - Street 2:STE 110
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1680
Practice Address - Country:US
Practice Address - Phone:626-280-6212
Practice Address - Fax:626-280-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000900Medicaid