MEDICARE: JUSTIN PRASAD, OD A PROFESSIONAL OPTOMETRIC CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT12697T	CA

General Provider Information

NPI Number	:	1184839482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTIN PRASAD, OD A PROFESSIONAL OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	6332 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1424
Country	:	US
Telephone Number	:	562-421-4488
Fax Number	:	562-421-0233

Provider Business Practice Location Address
First Line	:	6332 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1424
Country	:	US
Telephone Number	:	562-421-4488
Fax Number	:	562-421-0233

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JUSTIN PRASAD
Credential	:	O.D.
Telephone Number	:	562-421-4488

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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