Provider Demographics
NPI:1962985440
Name:OPTICA DAMIAN OPTOMETRY
Entity type:Organization
Organization Name:OPTICA DAMIAN OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:YADIRA
Authorized Official - Last Name:DAMIAN-SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-321-0117
Mailing Address - Street 1:2860 S BRISTOL ST STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6200
Mailing Address - Country:US
Mailing Address - Phone:714-540-3993
Mailing Address - Fax:844-231-8874
Practice Address - Street 1:2860 S BRISTOL ST STE D
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6200
Practice Address - Country:US
Practice Address - Phone:714-540-3993
Practice Address - Fax:844-231-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2833540Medicaid