Organization
BOOTH OPTOMETRY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY LOUISE KAYEKJIAN O.D. (OPTOMETRIST)
(714) 838-3210
Entity
Organization
Contact information
Practice address
1102 IRVINE BLVD, TUSTIN, CA 92780-3529
(714) 838-3210
(714) 838-5702
Mailing address
1102 IRVINE BLVD, TUSTIN, CA 92780-3529
(714) 838-3210
(714) 838-5702
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-11505-TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0115050
—
CA
Enumeration date
06/23/2011
Last updated
09/02/2011
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