Provider Demographics
NPI:1568666824
Name:PAUL S. CRISMON, O.D. INC
Entity Type:Organization
Organization Name:PAUL S. CRISMON, O.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRISMON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-864-6535
Mailing Address - Street 1:13800 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4033
Mailing Address - Country:US
Mailing Address - Phone:562-864-6535
Mailing Address - Fax:562-264-6538
Practice Address - Street 1:13800 SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4033
Practice Address - Country:US
Practice Address - Phone:562-864-6535
Practice Address - Fax:562-264-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5839T152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACQ931AMedicare PIN