Healthcare Provider Details

I. General information

NPI: 1639443120
Provider Name (Legal Business Name): SUSAN KASPIAN, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 PACIFIC COAST HWY
LOMITA CA
90717-2719
US

IV. Provider business mailing address

1735 PACIFIC COAST HWY
LOMITA CA
90717-2719
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-0986
  • Fax: 310-325-0790
Mailing address:
  • Phone: 310-325-0986
  • Fax: 310-325-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number13200
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number13200
License Number StateCA

VIII. Authorized Official

Name: DR. SUSAN J. KASPIAN
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 310-325-0986