Provider Demographics
NPI:1508499666
Name:AGOP, NATALENE
Entity Type:Individual
Prefix:
First Name:NATALENE
Middle Name:
Last Name:AGOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44407 10TH ST W
Mailing Address - Street 2:STE B
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3345
Mailing Address - Country:US
Mailing Address - Phone:661-942-3849
Mailing Address - Fax:
Practice Address - Street 1:44407 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3345
Practice Address - Country:US
Practice Address - Phone:661-942-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34730152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program