Healthcare Provider Details

I. General information

NPI: 1386638476
Provider Name (Legal Business Name): ALLEN E. AUSTIN O. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CITY BLVD W SUITE #111
ORANGE CA
92868-3621
US

IV. Provider business mailing address

1 CITY BLVD W SUITE #111
ORANGE CA
92868-3621
US

V. Phone/Fax

Practice location:
  • Phone: 714-634-0033
  • Fax: 714-634-2277
Mailing address:
  • Phone: 714-634-0033
  • Fax: 714-634-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10743T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: