Provider Demographics
NPI:1649530536
Name:TARAS LITVIN, O.D., INC.
Entity type:Organization
Organization Name:TARAS LITVIN, O.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TARAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:LITVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-557-9279
Mailing Address - Street 1:921 TRANSPORT WAY
Mailing Address - Street 2:SUITE #18
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1461
Mailing Address - Country:US
Mailing Address - Phone:415-375-0042
Mailing Address - Fax:
Practice Address - Street 1:921 TRANSPORT WAY
Practice Address - Street 2:SUITE #18
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1461
Practice Address - Country:US
Practice Address - Phone:415-375-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13726TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty