Provider Demographics
NPI:1629223706
Name:ZIGGY'S OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:ZIGGY'S OPTOMETRY CORPORATION
Other - Org Name:ZIGGY'S OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAU-RU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-673-1883
Mailing Address - Street 1:3417 VIA LIDO
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3908
Mailing Address - Country:US
Mailing Address - Phone:949-673-1883
Mailing Address - Fax:949-673-1884
Practice Address - Street 1:3417 VIA LIDO
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3908
Practice Address - Country:US
Practice Address - Phone:949-673-1883
Practice Address - Fax:949-673-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13316T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB345OtherMEDICARE PTAN
CA6314090001Medicare NSC