Provider Demographics
NPI:1861189011
Name:DR. MIMIA WEN OPTOMETRY PC
Entity type:Organization
Organization Name:DR. MIMIA WEN OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MIMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-432-7894
Mailing Address - Street 1:2651 IRVINE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6620
Mailing Address - Country:US
Mailing Address - Phone:949-432-7894
Mailing Address - Fax:949-432-7880
Practice Address - Street 1:2651 IRVINE AVE STE 120
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6620
Practice Address - Country:US
Practice Address - Phone:949-439-8471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty