Provider Demographics
NPI:1912912601
Name:AGAPE EYE CARE OPTOMETRY, INC.
Entity Type:Organization
Organization Name:AGAPE EYE CARE OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MINAH
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-288-1287
Mailing Address - Street 1:8622 GARVEY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3291
Mailing Address - Country:US
Mailing Address - Phone:626-288-1287
Mailing Address - Fax:626-288-3229
Practice Address - Street 1:8622 GARVEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3291
Practice Address - Country:US
Practice Address - Phone:626-288-1287
Practice Address - Fax:626-288-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0127820Medicaid
CAV08765Medicare UPIN
CAW19691Medicare ID - Type Unspecified