Provider Demographics
NPI:1689944217
Name:UTOPIA OPTOMETRY
Entity Type:Organization
Organization Name:UTOPIA OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-593-4423
Mailing Address - Street 1:1552 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3434
Mailing Address - Country:US
Mailing Address - Phone:909-593-4423
Mailing Address - Fax:909-593-0176
Practice Address - Street 1:1552 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3434
Practice Address - Country:US
Practice Address - Phone:909-593-4423
Practice Address - Fax:909-593-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FY201AMedicare PIN