Provider Demographics
NPI:1851785141
Name:DOWNEY VISION OPTOMETRY, INC.
Entity Type:Organization
Organization Name:DOWNEY VISION OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY QUYEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:TIET
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-600-7017
Mailing Address - Street 1:10353 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2743
Mailing Address - Country:US
Mailing Address - Phone:562-923-5501
Mailing Address - Fax:562-923-8863
Practice Address - Street 1:10353 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2743
Practice Address - Country:US
Practice Address - Phone:562-923-5501
Practice Address - Fax:562-923-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11489 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114890Medicaid
CAV01638Medicare UPIN
CASD0114890Medicaid