Provider Demographics
NPI:1689724585
Name:ISRAEL, STEVEN (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 W AVENUE K
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5918
Mailing Address - Country:US
Mailing Address - Phone:661-942-7313
Mailing Address - Fax:661-948-1264
Practice Address - Street 1:1046 W AVENUE K
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5918
Practice Address - Country:US
Practice Address - Phone:661-942-7313
Practice Address - Fax:661-948-1264
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7966TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079660Medicaid
CAT70241Medicare ID - Type Unspecified
CASD0079660Medicaid