Provider Demographics
NPI:1770327033
Name:WESTERN VILLAGE OPTOMETRY, INC
Entity type:Organization
Organization Name:WESTERN VILLAGE OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-360-6664
Mailing Address - Street 1:301 S WESTERN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3816
Mailing Address - Country:US
Mailing Address - Phone:323-743-3468
Mailing Address - Fax:
Practice Address - Street 1:301 S WESTERN AVE STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3816
Practice Address - Country:US
Practice Address - Phone:323-743-3468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty