Healthcare Provider Details

I. General information

NPI: 1689476673
Provider Name (Legal Business Name): NANCY ODICHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6765 LANKERSHIM BLVD
NORTH HOLLYWOOD CA
91606-1614
US

IV. Provider business mailing address

6765 LANKERSHIM BLVD
NORTH HOLLYWOOD CA
91606-1614
US

V. Phone/Fax

Practice location:
  • Phone: 818-982-0076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35981TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: