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General NPI Number Information
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NPI Number | 1386746436
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Entity Type | Individual
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Provider Name | HENRY ETTINGER OD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 2705 TELLER RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-1190
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Country | US
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Telephone | 805-262-0038
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Fax |
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Provider Business Mailing Address
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Address Line | 42044 VILLAGE 42
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City | CAMARILLO
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State | CA
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Zip | 93012-8902
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Country | US
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Telephone | 646-648-2459
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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 | 7866
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License Number State | CA
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