Provider Demographics
NPI:1700272895
Name:IRENE P LOU, OD INC
Entity Type:Organization
Organization Name:IRENE P LOU, OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-557-5074
Mailing Address - Street 1:20468 CROOKED BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 HALLMARK PKWY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-1876
Practice Address - Country:US
Practice Address - Phone:909-887-1881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14734 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty