Basic Information
| Provider Information | |||||||||
| NPI: | 1134794746 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAWRENCE YU OPTOMETRY CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7250 CARSON BLVD | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908082358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623770941 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7250 CARSON BLVD | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908082358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623770941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2021 | ||||||||
| LastUpdateDate: | 06/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | YU | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5623770941 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 06/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.