Provider Demographics
NPI:1518537950
Name:ZHAO, EVALIN (OD)
Entity Type:Individual
Prefix:
First Name:EVALIN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-6901
Mailing Address - Country:US
Mailing Address - Phone:909-539-5712
Mailing Address - Fax:
Practice Address - Street 1:1701 STINE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4827
Practice Address - Country:US
Practice Address - Phone:661-459-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1942-878AT152W00000X
CAOPT34817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist