Provider Demographics
NPI:1932520889
Name:EYELOHA EYE CARE OPTOMETRY
Entity Type:Organization
Organization Name:EYELOHA EYE CARE OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-272-6843
Mailing Address - Street 1:1018 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4117
Mailing Address - Country:US
Mailing Address - Phone:858-272-6843
Mailing Address - Fax:858-272-8143
Practice Address - Street 1:1018 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4117
Practice Address - Country:US
Practice Address - Phone:858-272-6843
Practice Address - Fax:858-272-8143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10798T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP3752AMedicare UPIN