Provider Demographics
NPI:1639443120
Name:SUSAN KASPIAN, O.D.
Entity Type:Organization
Organization Name:SUSAN KASPIAN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-325-0986
Mailing Address - Street 1:1735 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2719
Mailing Address - Country:US
Mailing Address - Phone:310-325-0986
Mailing Address - Fax:310-325-0790
Practice Address - Street 1:1735 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2719
Practice Address - Country:US
Practice Address - Phone:310-325-0986
Practice Address - Fax:310-325-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13200302F00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX030AMedicare UPIN