Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 14957 | CA |
NPI | 1013323047 |
---|---|
Provider Name | Melissa Zhao |
First Address | San Dimas, CA 91773-2541 |
Second Address | San Dimas, CA 91773-2541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 03/12/2021 |