Provider Demographics
NPI:1639172273
Name:LARCABAL, JOHN E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:LARCABAL
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 1:12138 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4320
Mailing Address - Country:US
Mailing Address - Phone:562-868-8233
Mailing Address - Fax:562-868-8283
Practice Address - Street 1:12138 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4320
Practice Address - Country:US
Practice Address - Phone:562-868-8233
Practice Address - Fax:562-868-8283
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9029T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0090290Medicaid
CAU29756Medicare UPIN
CAOP9029Medicare ID - Type Unspecified
CAP00249241Medicare PIN