Provider Demographics
NPI:1821320532
Name:MARVIN R KASANOFF OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARVIN R KASANOFF OD A PROFESSIONAL CORPORATION
Other - Org Name:NEW VIEW OPTOMETRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:KASANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-465-7900
Mailing Address - Street 1:7339 EL CAJON BLVD
Mailing Address - Street 2:G
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7435
Mailing Address - Country:US
Mailing Address - Phone:619-465-7900
Mailing Address - Fax:619-839-3840
Practice Address - Street 1:7339 EL CAJON BLVD
Practice Address - Street 2:G
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7435
Practice Address - Country:US
Practice Address - Phone:619-465-7900
Practice Address - Fax:619-839-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87755T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0087550Medicaid
CAOP8755AOtherMEDICARE NUMBER
CAT70283Medicare UPIN
CADB261AMedicare PIN