Healthcare Provider Details

I. General information

NPI: 1982811600
Provider Name (Legal Business Name): JOHN LARCABAL OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12029 FIRESTONE BLVD
NORWALK CA
90650-2908
US

IV. Provider business mailing address

12029 FIRESTONE BLVD
NORWALK CA
90650-2908
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-8233
  • Fax: 562-868-8283
Mailing address:
  • Phone: 562-868-8233
  • Fax: 562-868-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9029T
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN LARCABAL
Title or Position: OWNER
Credential: O.D.
Phone: 562-868-8233