Provider Demographics
NPI:1437494564
Name:MONTEREY PARK OPTOMETRY, INC
Entity Type:Organization
Organization Name:MONTEREY PARK OPTOMETRY, INC
Other - Org Name:MPO EYECARE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:VI
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-573-9336
Mailing Address - Street 1:349 E MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7909
Mailing Address - Country:US
Mailing Address - Phone:626-573-9336
Mailing Address - Fax:626-573-0933
Practice Address - Street 1:349 E MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7909
Practice Address - Country:US
Practice Address - Phone:626-573-9336
Practice Address - Fax:626-573-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 12725 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty