Provider Demographics
NPI:1023009693
Name:TON, LIEU THAT (OD)
Entity type:Individual
Prefix:DR
First Name:LIEU
Middle Name:THAT
Last Name:TON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:358 N LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2345
Mailing Address - Country:US
Mailing Address - Phone:909-869-9448
Mailing Address - Fax:909-869-9354
Practice Address - Street 1:358 N LEMON AVE
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2345
Practice Address - Country:US
Practice Address - Phone:909-869-9448
Practice Address - Fax:909-869-9354
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10557TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS00105570Medicaid
CAS00105570Medicaid
CA1699780379Medicare PIN