Provider Demographics
NPI:1528188448
Name:COVINA EYECARE OPTOMETRY INC
Entity Type:Organization
Organization Name:COVINA EYECARE OPTOMETRY INC
Other - Org Name:EDWIN WU, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-967-3794
Mailing Address - Street 1:911 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2046
Mailing Address - Country:US
Mailing Address - Phone:626-967-3794
Mailing Address - Fax:626-967-8404
Practice Address - Street 1:911 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2046
Practice Address - Country:US
Practice Address - Phone:626-967-3794
Practice Address - Fax:626-967-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13985 TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070980Medicaid
WOD7098DMedicare PIN
CASD0070980Medicaid