Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT34045TLG | CA |
NPI | 1013493683 |
---|---|
Provider Name | Dr. Benjamin J Szu |
First Address | Irvine, CA 92612-8545 |
Second Address | Costa Mesa, CA 92626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2018 |
Last Update Date | 16/10/2019 |