Provider Demographics
NPI:1588647325
Name:STEIN, HOWARD E (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:E
Last Name:STEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE E4
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2458
Mailing Address - Country:US
Mailing Address - Phone:310-546-5568
Mailing Address - Fax:310-546-5421
Practice Address - Street 1:3200 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE E4
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2458
Practice Address - Country:US
Practice Address - Phone:310-546-5568
Practice Address - Fax:310-546-5421
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4311TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5D0043110Medicaid
CAWOP04311Medicare ID - Type Unspecified
CA5D0043110Medicaid