Provider Demographics
NPI:1093795544
Name:EAP OPTOMETRY
Entity Type:Organization
Organization Name:EAP OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:HOR-BENG
Authorized Official - Last Name:EAP
Authorized Official - Suffix:
Authorized Official - Credentials:OD, JD
Authorized Official - Phone:562-496-3365
Mailing Address - Street 1:6541 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4023
Mailing Address - Country:US
Mailing Address - Phone:562-496-3365
Mailing Address - Fax:
Practice Address - Street 1:6541 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-4023
Practice Address - Country:US
Practice Address - Phone:562-496-3365
Practice Address - Fax:562-496-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10107T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0101070Medicaid
U50233Medicare UPIN
CAOP10107Medicare ID - Type Unspecified