Provider Demographics
NPI:1083505770
Name:IMPERIAL VALLEY OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:IMPERIAL VALLEY OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-484-1500
Mailing Address - Street 1:9320 CARMEL MOUNTAIN RD STE E
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2159
Mailing Address - Country:US
Mailing Address - Phone:858-484-1500
Mailing Address - Fax:
Practice Address - Street 1:9320 CARMEL MOUNTAIN RD STE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2159
Practice Address - Country:US
Practice Address - Phone:858-484-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty