MEDICARE: SIZHUO KAN OPTICIAN

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	156FX1800X	Optician	SLD42180	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F8121196	OTHER	CA	EYEMED

General Provider Information

NPI Number	:	1316532468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIZHUO KAN OPTICIAN

Provider Business Mailing Address
First Line	:	18475 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2805
Country	:	US
Telephone Number	:	626-346-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	18475 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2805
Country	:	US
Telephone Number	:	626-346-3770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/01/2021

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Directions to “ SIZHUO KAN OPTICIAN” Practice Location

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