Provider Demographics
NPI:1912453820
Name:RHEN, ARIC (OD)
Entity type:Individual
Prefix:DR
First Name:ARIC
Middle Name:
Last Name:RHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 FEDERAL AVE
Mailing Address - Street 2:APT. 18
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3962
Mailing Address - Country:US
Mailing Address - Phone:310-625-6340
Mailing Address - Fax:
Practice Address - Street 1:16542 VENTURA BLVD
Practice Address - Street 2:400
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2005
Practice Address - Country:US
Practice Address - Phone:310-625-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12706152W00000X
MN3003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist