Provider Demographics
NPI:1417017385
Name:SEN, EFFIE (OD)
Entity Type:Individual
Prefix:
First Name:EFFIE
Middle Name:
Last Name:SEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23641 GOLDEN SPRINGS DR UNIT 8C
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2168
Mailing Address - Country:US
Mailing Address - Phone:909-861-3737
Mailing Address - Fax:909-396-7517
Practice Address - Street 1:1255 S DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4122
Practice Address - Country:US
Practice Address - Phone:909-861-3737
Practice Address - Fax:909-396-7517
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12773TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMSK1463861OtherDEA