Provider Demographics
NPI:1013058643
Name:DEUTSCH, DAN (OPTIAN)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:DEUTSCH
Suffix:
Gender:M
Credentials:OPTIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 STEIN PLZ
Mailing Address - Street 2:#1-231
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-206-7184
Mailing Address - Fax:310-825-9108
Practice Address - Street 1:200 STEIN PLZ
Practice Address - Street 2:#1-231
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-7184
Practice Address - Fax:310-825-9108
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6277156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX006277FMedicaid
CA1150220001Medicare ID - Type Unspecified