Provider Demographics
NPI:1043416860
Name:RAINBOW OPTOMETRY,INC.
Entity Type:Organization
Organization Name:RAINBOW OPTOMETRY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LI-YI
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-608-0601
Mailing Address - Street 1:1183 E FOOTHILL BLVD
Mailing Address - Street 2:#140
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4049
Mailing Address - Country:US
Mailing Address - Phone:909-608-0601
Mailing Address - Fax:909-608-0610
Practice Address - Street 1:1183 E FOOTHILL BLVD # 140
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4049
Practice Address - Country:US
Practice Address - Phone:909-608-0601
Practice Address - Fax:909-608-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10945T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ07140ZMedicare PIN
CA5975210001Medicare NSC