Provider Demographics
NPI:1033517008
Name:OPTOMETRIC ALLIANCE INC
Entity Type:Organization
Organization Name:OPTOMETRIC ALLIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-737-7319
Mailing Address - Street 1:2360 HUNTINGTON DR
Mailing Address - Street 2:#210
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2656
Mailing Address - Country:US
Mailing Address - Phone:626-737-7319
Mailing Address - Fax:
Practice Address - Street 1:2360 HUNTINGTON DR
Practice Address - Street 2:#200
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2656
Practice Address - Country:US
Practice Address - Phone:626-737-7319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty