Healthcare Provider Details

I. General information

NPI: 1609007830
Provider Name (Legal Business Name): LAURA K HA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7217 RESEDA BLVD
RESEDA CA
91335-3046
US

IV. Provider business mailing address

7217 RESEDA BLVD
RESEDA CA
91335-3046
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-2010
  • Fax: 818-345-2070
Mailing address:
  • Phone: 818-345-2010
  • Fax: 818-345-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13789
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number13789
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1588940647
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerMEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: