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NPI Code Detail

MEDICARE: DR. DARREN L THORSEN O.D.

MEDICARE:  DR. DARREN L THORSEN  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
1152W00000XOptometrist3069TXWA
2152W00000XOptometrist2483TOR

Other Identifiers

General Provider Information

NPI Number : 1720082415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DARREN L THORSEN O.D.
Provider Business Mailing Address
First Line : 1703 PACIFIC AVE S
Second Line :
City : LONG BEACH
State : WA
Zip : 98631-3400
Country : US
Telephone Number : 360-642-3214
Fax Number : 360-642-5333
Provider Business Practice Location Address
First Line : 1703 PACIFIC AVE S
Second Line :
City : LONG BEACH
State : WA
Zip : 98631-3400
Country : US
Telephone Number : 360-642-3214
Fax Number : 360-642-5333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 10/14/2011

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Directions to “ DR. DARREN L THORSEN O.D.” Practice Location

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