Provider Demographics
NPI:1588940647
Name:LAURA K. HA OD OPTOMETRY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LAURA K. HA OD OPTOMETRY A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-345-2010
Mailing Address - Street 1:7217 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3046
Mailing Address - Country:US
Mailing Address - Phone:818-345-2010
Mailing Address - Fax:818-345-2070
Practice Address - Street 1:7217 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3046
Practice Address - Country:US
Practice Address - Phone:818-345-2010
Practice Address - Fax:818-345-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13789152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFO156AMedicare PIN