Provider Demographics
NPI:1942854328
Name:HONDA, OLIVIA JUNE (OD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:JUNE
Last Name:HONDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13881 SAN ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7428
Mailing Address - Country:US
Mailing Address - Phone:909-614-9779
Mailing Address - Fax:
Practice Address - Street 1:400 NEWPORT CENTER DR STE 404
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7687
Practice Address - Country:US
Practice Address - Phone:949-640-2023
Practice Address - Fax:949-640-7182
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT34253-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist