Healthcare Provider Details

I. General information

NPI: 1417516956
Provider Name (Legal Business Name): OMAR KRAD MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N HARBOR BLVD STE 100
FULLERTON CA
92835-4107
US

IV. Provider business mailing address

18 SUNSWEPT MESA
ALISO VIEJO CA
92656-8074
US

V. Phone/Fax

Practice location:
  • Phone: 949-309-8148
  • Fax: 714-526-2020
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OMAR KRAD
Title or Position: PRESIDENT
Credential: MD
Phone: 949-309-8148