Provider Demographics
NPI:1619295334
Name:SO, EMILY K (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:SO
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:301 W. HUNTINGTON DR.
Mailing Address - Street 2:SUITE #107
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3400
Mailing Address - Country:US
Mailing Address - Phone:626-574-0022
Mailing Address - Fax:626-574-0040
Practice Address - Street 1:17833 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1729
Practice Address - Country:US
Practice Address - Phone:626-964-7764
Practice Address - Fax:626-913-2910
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CATLG13859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEN061HOtherMEDICARE PTAN