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General NPI Number Information
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NPI Number | 1639443120
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Entity Type | Organization
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Legal Business Name | SUSAN KASPIAN, O.D.
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 1735 PACIFIC COAST HWY
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City | LOMITA
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State | CA
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Zip | 90717-2719
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Country | US
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Telephone | 310-325-0986
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Fax | 310-325-0790
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Provider Business Mailing Address
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Address Line | 1735 PACIFIC COAST HWY
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City | LOMITA
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State | CA
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Zip | 90717-2719
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Country | US
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Telephone | 310-325-0986
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Fax | 310-325-0790
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. SUSAN J. KASPIAN
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Credential | O.D.
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Telephone | 310-325-0986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 13200
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 13200
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License Number State | CA
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