Provider Demographics
NPI:1609007830
Name:HA, LAURA K (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:K
Last Name:HA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7217 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3046
Mailing Address - Country:US
Mailing Address - Phone:818-345-2010
Mailing Address - Fax:818-345-2070
Practice Address - Street 1:7217 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3046
Practice Address - Country:US
Practice Address - Phone:818-345-2010
Practice Address - Fax:818-345-2070
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13789152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588940647OtherMEDICARE