Provider Demographics
NPI:1588638407
Name:VISION QUEST OPTOMETRY, INC.
Entity type:Organization
Organization Name:VISION QUEST OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUNG
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-357-0408
Mailing Address - Street 1:937 W HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3111
Mailing Address - Country:US
Mailing Address - Phone:626-357-0408
Mailing Address - Fax:626-357-6768
Practice Address - Street 1:937 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3111
Practice Address - Country:US
Practice Address - Phone:626-357-0408
Practice Address - Fax:626-357-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10499T152W00000X
CA10381T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0104991Medicaid
CASD0103810Medicaid
CAU57606Medicare ID - Type Unspecified
CASD0103810Medicaid