Provider Demographics
NPI:1659447936
Name:ALLEN E AUSTIN OD INC
Entity Type:Organization
Organization Name:ALLEN E AUSTIN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-634-0033
Mailing Address - Street 1:1 CITY BLVD W
Mailing Address - Street 2:#111
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3621
Mailing Address - Country:US
Mailing Address - Phone:714-634-0033
Mailing Address - Fax:714-634-2277
Practice Address - Street 1:1 CITY BLVD W
Practice Address - Street 2:#111
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3621
Practice Address - Country:US
Practice Address - Phone:714-634-0033
Practice Address - Fax:714-634-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15746Medicare ID - Type Unspecified