Provider Demographics
NPI:1497721427
Name:LAI, DANITA (OD)
Entity Type:Individual
Prefix:DR
First Name:DANITA
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DANITA
Other - Middle Name:
Other - Last Name:SAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:28222 AGOURA RD STE 400
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2411
Mailing Address - Country:US
Mailing Address - Phone:818-597-0070
Mailing Address - Fax:818-597-0278
Practice Address - Street 1:28222 AGOURA RD STE 400
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2411
Practice Address - Country:US
Practice Address - Phone:818-597-0070
Practice Address - Fax:818-597-0278
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8019TLG152W00000X
CA8019 TPL152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0380900002OtherPTAN#
CASD0080190Medicaid
CA0380900002Medicare NSC
CA0380900002OtherPTAN#
CASD0080190Medicaid