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General NPI Number Information
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NPI Number | 1710544820
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Entity Type | Organization
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Legal Business Name | KRISTA RODEN, O.D., INC.
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 24581 COPPER HILL DR
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City | VALENCIA
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State | CA
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Zip | 91354
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Country | US
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Telephone | 612-743-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 24917 MAGIC MOUNTAIN PKWY APT 811
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City | VALENCIA
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State | CA
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Zip | 91355-4696
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Country | US
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Telephone | 612-743-2030
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRISTA RODEN
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Credential | OD
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Telephone | 612-743-2030
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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 |
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License Number State |
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