Provider Demographics
NPI:1528821956
Name:FENIX LUMI, CORP
Entity type:Organization
Organization Name:FENIX LUMI, CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNSIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-438-1185
Mailing Address - Street 1:4880 GLENVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22500 TOWN CIR STE 2108
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7517
Practice Address - Country:US
Practice Address - Phone:951-656-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty