Healthcare Provider Details

I. General information

NPI: 1912389354
Provider Name (Legal Business Name): ERICA DANIELLE BARANWAL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERICA DANIELLE O'BRIEN O.D.

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5832 BEACH BLVD UNIT 109
BUENA PARK CA
90621-5500
US

IV. Provider business mailing address

3651 WELLINGTON RD
LOS ANGELES CA
90016-4260
US

V. Phone/Fax

Practice location:
  • Phone: 714-228-1888
  • Fax: 714-676-8308
Mailing address:
  • Phone: 614-309-7823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: