Provider Demographics
NPI:1366830861
Name:VISION MASTER OPTICAL
Entity Type:Organization
Organization Name:VISION MASTER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:SHAO
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-280-2882
Mailing Address - Street 1:946 E GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755
Mailing Address - Country:US
Mailing Address - Phone:626-280-2882
Mailing Address - Fax:626-228-2548
Practice Address - Street 1:946 E GARVEY AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755
Practice Address - Country:US
Practice Address - Phone:626-280-2882
Practice Address - Fax:626-228-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI26209332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9155931Medicaid
CA9155931Medicaid