Provider Demographics
NPI:1023394228
Name:NA, AEREE (OD)
Entity Type:Individual
Prefix:DR
First Name:AEREE
Middle Name:
Last Name:NA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 S WESTERN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3387
Mailing Address - Country:US
Mailing Address - Phone:213-334-1001
Mailing Address - Fax:
Practice Address - Street 1:833 S WESTERN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3387
Practice Address - Country:US
Practice Address - Phone:213-334-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14322T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist