Provider Demographics
NPI:1063498616
Name:ENENSTEIN, HARRY E (O D)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:E
Last Name:ENENSTEIN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17310 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3904
Mailing Address - Country:US
Mailing Address - Phone:818-728-6800
Mailing Address - Fax:
Practice Address - Street 1:17310 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3904
Practice Address - Country:US
Practice Address - Phone:818-728-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4796T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952689385OtherTAX ID
CAGSD000700Medicaid
CAWOP4796BMedicare PIN
CA952689385OtherTAX ID