Provider Demographics
NPI:1326375213
Name:PAULINA T.Q. HAN O.D. INC.
Entity Type:Organization
Organization Name:PAULINA T.Q. HAN O.D. INC.
Other - Org Name:TEMPLE CITY SQUARE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULINA
Authorized Official - Middle Name:TQ
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-287-8505
Mailing Address - Street 1:5803 ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1833
Mailing Address - Country:US
Mailing Address - Phone:626-287-8505
Mailing Address - Fax:626-287-2645
Practice Address - Street 1:5803 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1833
Practice Address - Country:US
Practice Address - Phone:626-287-8505
Practice Address - Fax:626-287-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11057T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0110570Medicaid
CASD0110570Medicaid