Provider Demographics
NPI:1578786398
Name:PRIMIGENIA OPTOMETRY INC
Entity Type:Organization
Organization Name:PRIMIGENIA OPTOMETRY INC
Other - Org Name:VISION MAX OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIA
Authorized Official - Middle Name:MENGYA
Authorized Official - Last Name:HUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-939-4588
Mailing Address - Street 1:14461 MERCED AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5100
Mailing Address - Country:US
Mailing Address - Phone:626-939-4588
Mailing Address - Fax:626-939-4590
Practice Address - Street 1:14461 MERCED AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5100
Practice Address - Country:US
Practice Address - Phone:626-939-4588
Practice Address - Fax:626-939-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9757 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578786398Medicaid
CAGS997AMedicare PIN
CA1578786398Medicaid