Provider Demographics
NPI:1336789296
Name:DIAMOND VISION OPTOMETRY ASSOCIATES AND GTC OPTOMETRY
Entity Type:Organization
Organization Name:DIAMOND VISION OPTOMETRY ASSOCIATES AND GTC OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-683-6868
Mailing Address - Street 1:350 S LAKE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3553
Mailing Address - Country:US
Mailing Address - Phone:626-683-6868
Mailing Address - Fax:626-782-6162
Practice Address - Street 1:350 S LAKE AVE STE 111
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3553
Practice Address - Country:US
Practice Address - Phone:626-683-6868
Practice Address - Fax:626-782-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty