Provider Demographics
NPI:1487020483
Name:DARREN OSTERLOH OD INC
Entity Type:Organization
Organization Name:DARREN OSTERLOH OD INC
Other - Org Name:DARREN F OSTERLOH
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTERLOH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-777-8888
Mailing Address - Street 1:3900 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3654
Mailing Address - Country:US
Mailing Address - Phone:805-777-8888
Mailing Address - Fax:
Practice Address - Street 1:3900 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3654
Practice Address - Country:US
Practice Address - Phone:805-777-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA284357Medicare UPIN
CAOP9922Medicare PIN