Healthcare Provider Details

I. General information

NPI: 1073573515
Provider Name (Legal Business Name): ADAM D. KRAHLING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14329 WOODRUFF AVE SUITE E
BELLFLOWER CA
90706-3260
US

IV. Provider business mailing address

15744 CRESWICK DR
LA MIRADA CA
90638-1504
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-8302
  • Fax: 562-867-7046
Mailing address:
  • Phone: 562-743-6858
  • Fax: 562-943-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT 5236 TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: