Provider Demographics
NPI:1578620274
Name:SIENNE S. VAN ENK
Entity Type:Organization
Organization Name:SIENNE S. VAN ENK
Other - Org Name:OPTOMETRIC CONCIERGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SIENNE
Authorized Official - Middle Name:SANTAMARIA
Authorized Official - Last Name:VAN ENK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-325-7855
Mailing Address - Street 1:26640 WESTERN AVE
Mailing Address - Street 2:SUITE R
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3600
Mailing Address - Country:US
Mailing Address - Phone:310-325-7855
Mailing Address - Fax:310-325-7955
Practice Address - Street 1:26640 WESTERN AVE
Practice Address - Street 2:SUITE R
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3600
Practice Address - Country:US
Practice Address - Phone:310-325-7855
Practice Address - Fax:310-325-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10560T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0105600Medicaid
CAOP10560Medicare PIN
CASD0105600Medicaid