Provider Demographics
NPI:1063540946
Name:SON, JOHN S (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:SON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4325 W 182ND ST
Mailing Address - Street 2:UNIT #22
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4535
Mailing Address - Country:US
Mailing Address - Phone:310-371-5501
Mailing Address - Fax:
Practice Address - Street 1:2601 SKYPARK DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5313
Practice Address - Country:US
Practice Address - Phone:310-534-2939
Practice Address - Fax:310-534-2729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11215T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist