Provider Demographics
NPI:1275845117
Name:LAN, ESTHER (OD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:LAN
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 1:13800 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4033
Mailing Address - Country:US
Mailing Address - Phone:562-864-6535
Mailing Address - Fax:562-864-6538
Practice Address - Street 1:13800 SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-864-6535
Practice Address - Fax:562-864-6538
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist