Provider Demographics
NPI:1558636753
Name:ADRIAN V POP O.D. INC.
Entity Type:Organization
Organization Name:ADRIAN V POP O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-288-8282
Mailing Address - Street 1:2501 E CHAPMAN AVE # 105
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3204
Mailing Address - Country:US
Mailing Address - Phone:714-288-8282
Mailing Address - Fax:714-288-8285
Practice Address - Street 1:2501 E CHAPMAN AVE # 105
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3204
Practice Address - Country:US
Practice Address - Phone:714-288-8282
Practice Address - Fax:714-288-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11262T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP11262Medicaid
CAOP11262Medicaid