Provider Demographics
NPI:1558776435
Name:VIP VISION PC
Entity Type:Organization
Organization Name:VIP VISION PC
Other - Org Name:DIAMOND VISION INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-799-2075
Mailing Address - Street 1:103 N GARFIELD AVE STE E
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3578
Mailing Address - Country:US
Mailing Address - Phone:626-799-2075
Mailing Address - Fax:626-790-4554
Practice Address - Street 1:103 N GARFIELD AVE STE E
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-799-2075
Practice Address - Fax:626-790-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11984207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB223193Medicare PIN
CACB223192Medicare PIN
CACA137296Medicare PIN