Provider Demographics
NPI:1326205568
Name:DR CARMELA LARINO OD, INC
Entity Type:Organization
Organization Name:DR CARMELA LARINO OD, INC
Other - Org Name:WALNUT HILLS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-965-3878
Mailing Address - Street 1:18800 AMAR RD STE A5
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-7100
Mailing Address - Country:US
Mailing Address - Phone:626-965-3878
Mailing Address - Fax:626-965-5662
Practice Address - Street 1:18800 AMAR RD STE A5
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-7100
Practice Address - Country:US
Practice Address - Phone:626-965-3878
Practice Address - Fax:626-965-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10504332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0105040Medicaid
CAU63032Medicare UPIN