Provider Demographics
NPI:1245282540
Name:CONN, HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:CONN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 1007
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3711
Mailing Address - Country:US
Mailing Address - Phone:949-727-0102
Mailing Address - Fax:949-753-0291
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 1007
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-727-0102
Practice Address - Fax:949-753-0291
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37220207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC1599262OtherBNDD NUMBER
CAC37220OtherMEDICAL LICENSE
CAC37220OtherMEDICAL LICENSE
CAC37220Medicare ID - Type Unspecified