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General NPI Number Information
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NPI Number | 1154723997
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Entity Type | Individual
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Provider Name | SARAH REYES HAAKONSEN O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD STE 750
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City | ENCINO
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State | CA
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Zip | 91436-4325
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Country | US
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Telephone | 818-990-3623
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Fax | 818-788-5601
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Provider Business Mailing Address
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Address Line | 5461 LUIS DR
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4064
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Country | US
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Telephone | 818-807-2370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9567T
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License Number State | CA
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