Provider Demographics
NPI:1124076849
Name:OSTERLOH, DARREN (OD)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:OSTERLOH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:DARREN
Other - Middle Name:
Other - Last Name:OSTERLOH OD INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3900 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3654
Mailing Address - Country:US
Mailing Address - Phone:805-777-8888
Mailing Address - Fax:805-777-8887
Practice Address - Street 1:3900 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3654
Practice Address - Country:US
Practice Address - Phone:805-777-8888
Practice Address - Fax:805-777-8887
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9922 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA284357Medicare UPIN
CAOP9922Medicare PIN