Provider Demographics
NPI:1518520667
Name:LIVE LIFE OPTICAL INC
Entity Type:Organization
Organization Name:LIVE LIFE OPTICAL INC
Other - Org Name:LIVE LIFE OPTICAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-765-9586
Mailing Address - Street 1:11421 CARSON ST STE D
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2500
Mailing Address - Country:US
Mailing Address - Phone:562-860-4590
Mailing Address - Fax:562-860-4591
Practice Address - Street 1:11421 CARSON ST STE D
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-2500
Practice Address - Country:US
Practice Address - Phone:562-860-4590
Practice Address - Fax:562-860-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty