Provider Demographics
NPI:1184839482
Name:JUSTIN PRASAD, OD A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:JUSTIN PRASAD, OD A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:LONG BEACH FAMILY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-421-4488
Mailing Address - Street 1:6332 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1424
Mailing Address - Country:US
Mailing Address - Phone:562-421-4488
Mailing Address - Fax:562-421-0233
Practice Address - Street 1:6332 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1424
Practice Address - Country:US
Practice Address - Phone:562-421-4488
Practice Address - Fax:562-421-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12697T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty