Basic Information
| Provider Information | |||||||||
| NPI: | 1891127858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOU | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | PULIDO | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 HALLMARK PKWY | ||||||||
| Address2: | #2 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924071876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098871881 | ||||||||
| FaxNumber: | 9098878557 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 HALLMARK PKWY | ||||||||
| Address2: | #2 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924071876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098871881 | ||||||||
| FaxNumber: | 9098878557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2013 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 14734 | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.