Provider Demographics
NPI:1851711139
Name:LY, JESSICA TRANG (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:TRANG
Last Name:LY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:618 W HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3206
Mailing Address - Country:US
Mailing Address - Phone:323-303-1966
Mailing Address - Fax:626-358-7448
Practice Address - Street 1:618 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3206
Practice Address - Country:US
Practice Address - Phone:323-303-1966
Practice Address - Fax:626-358-7448
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14782TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist