Provider Demographics
NPI:1598965568
Name:LAO, JIA (OD)
Entity Type:Individual
Prefix:DR
First Name:JIA
Middle Name:
Last Name:LAO
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 1:51 CITRUS GLN
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4173
Mailing Address - Country:US
Mailing Address - Phone:646-732-5571
Mailing Address - Fax:
Practice Address - Street 1:140 W VALLEY BLVD STE 115
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3784
Practice Address - Country:US
Practice Address - Phone:626-288-8023
Practice Address - Fax:626-288-8326
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007196152W00000X
IL046.010296152W00000X
CA14574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist