Healthcare Provider Details

I. General information

NPI: 1124983309
Provider Name (Legal Business Name): CAITLIN BOZNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22304 PINTADO
IRVINE CA
92618-0608
US

IV. Provider business mailing address

22304 PINTADO
IRVINE CA
92618-0608
US

V. Phone/Fax

Practice location:
  • Phone: 951-833-5453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT36138-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: