MEDICARE: DR. KRISTA RODEN O.D.

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	33476	CA

General Provider Information

NPI Number	:	1528410834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTA RODEN O.D.

Provider Business Mailing Address
First Line	:	2109 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2003
Country	:	US
Telephone Number	:	323-660-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2003
Country	:	US
Telephone Number	:	323-660-2020
Fax Number	:

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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