Provider Demographics
NPI:1114613098
Name:WYSE WILLA OPTOMETRY, INC.
Entity Type:Organization
Organization Name:WYSE WILLA OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/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:626-796-3105
Mailing Address - Street 1:1609 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5312
Mailing Address - Country:US
Mailing Address - Phone:323-663-8346
Mailing Address - Fax:323-663-2316
Practice Address - Street 1:1609 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5312
Practice Address - Country:US
Practice Address - Phone:323-663-8346
Practice Address - Fax:323-663-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty