Provider Demographics
NPI:1831669357
Name:OPTIKA OPTOMETRICS
Entity Type:Organization
Organization Name:OPTIKA OPTOMETRICS
Other - Org Name:OPTIKA OPTOMETRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:KWAN YANG
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-610-6727
Mailing Address - Street 1:17134 COLIMA RD STE B&C
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6737
Mailing Address - Country:US
Mailing Address - Phone:626-912-3937
Mailing Address - Fax:626-469-4949
Practice Address - Street 1:451 W FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3363
Practice Address - Country:US
Practice Address - Phone:626-969-7859
Practice Address - Fax:626-969-7849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIKA OPTOMETRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-27
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962869545Medicaid
CA1473Medicaid
CA1053473728Medicaid