Provider Demographics
NPI:1124162151
Name:KASPIAN, SUSAN J (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:KASPIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2719
Mailing Address - Country:US
Mailing Address - Phone:310-540-5115
Mailing Address - Fax:310-540-5118
Practice Address - Street 1:1735 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717
Practice Address - Country:US
Practice Address - Phone:310-325-0986
Practice Address - Fax:310-325-0790
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX030AMedicare PIN