MEDICARE: DR. LAURA K HA 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	13789	CA
2	152WP0200X	Pediatric Optometrist	13789	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588940647	OTHER	CA	MEDICARE

General Provider Information

NPI Number	:	1609007830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA K HA O.D.

Provider Business Mailing Address
First Line	:	7217 RESEDA BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3046
Country	:	US
Telephone Number	:	818-345-2010
Fax Number	:	818-345-2070

Provider Business Practice Location Address
First Line	:	7217 RESEDA BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3046
Country	:	US
Telephone Number	:	818-345-2010
Fax Number	:	818-345-2070

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

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	02/05/2026

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