Provider Demographics
NPI:1851820872
Name:NORCO VALLEY OPTOMETRY, INC
Entity Type:Organization
Organization Name:NORCO VALLEY OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-826-5576
Mailing Address - Street 1:1524 4TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1974
Mailing Address - Country:US
Mailing Address - Phone:951-407-1238
Mailing Address - Fax:951-407-1235
Practice Address - Street 1:1524 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1974
Practice Address - Country:US
Practice Address - Phone:951-407-1238
Practice Address - Fax:951-407-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA011699T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA011699TOtherOPTOMETRY