Provider Demographics
NPI:1275849887
Name:CLEAROPTIX OPTOMETRIC GROUP
Entity Type:Organization
Organization Name:CLEAROPTIX OPTOMETRIC GROUP
Other - Org Name:THE EYE DOCTOR OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUONG
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:TRANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-210-3405
Mailing Address - Street 1:9972 BOLSA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6069
Mailing Address - Country:US
Mailing Address - Phone:714-210-3405
Mailing Address - Fax:714-455-1556
Practice Address - Street 1:9972 BOLSA AVE STE 105
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6069
Practice Address - Country:US
Practice Address - Phone:714-210-3405
Practice Address - Fax:714-455-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14011TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0131220Medicaid
CAFK592AMedicare PIN
CAOP13122Medicare PIN