Healthcare Provider Details

I. General information

NPI: 1558510834
Provider Name (Legal Business Name): DARIN EYE CENTER A MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HAALAND DR STE 103
THOUSAND OAKS CA
91361-5230
US

IV. Provider business mailing address

425 HAALAND DR STE 103
THOUSAND OAKS CA
91361-5230
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-2020
  • Fax: 818-787-8652
Mailing address:
  • Phone: 805-778-1034
  • Fax: 805-778-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberW20551
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberG044103
License Number StateCA

VIII. Authorized Official

Name: EDWARD CHUNG
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-275-0009