Healthcare Provider Details

I. General information

NPI: 1881631885
Provider Name (Legal Business Name): LARRY LEE ALENBAUGH O.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N RENO ST
LOS ANGELES CA
90026-4656
US

IV. Provider business mailing address

950 S GRAND AVE FL 2
LOS ANGELES CA
90015-3999
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-4326
  • Fax: 323-953-3658
Mailing address:
  • Phone: 323-669-4346
  • Fax: 323-635-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 12542T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: