Provider Demographics
NPI:1508420290
Name:GENE S. MAH, O.D., AN OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:GENE S. MAH, O.D., AN OPTOMETRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-602-2717
Mailing Address - Street 1:14501 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3601
Mailing Address - Country:US
Mailing Address - Phone:562-602-2717
Mailing Address - Fax:
Practice Address - Street 1:14501 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3601
Practice Address - Country:US
Practice Address - Phone:562-602-2717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811045701OtherMEDICAL