Provider Demographics
NPI:1770731242
Name:WEI, JOLYN (OD)
Entity type:Individual
Prefix:
First Name:JOLYN
Middle Name:
Last Name:WEI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 PAXTON ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2352
Mailing Address - Country:US
Mailing Address - Phone:818-890-9600
Mailing Address - Fax:
Practice Address - Street 1:13550 PAXTON ST
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2352
Practice Address - Country:US
Practice Address - Phone:818-890-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13614TLG152W00000X
WAOD60113928152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty