Individual
ELAINE PYNG OETOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9340 W NORTHERN AVE STE 120, GLENDALE, AZ 85305-1148
(602) 794-1608
Mailing address
39 DEER TRAK, IRVINE, CA 92618-8812
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-002345
AZ
Other
Enumeration date
06/12/2019
Last updated
01/24/2024
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