Provider Demographics
NPI:1669409710
Name:LEVENTHAL, ALAN H (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:H
Last Name:LEVENTHAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24707 RIVERCHASE DR APT 7204
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1428
Mailing Address - Country:US
Mailing Address - Phone:619-507-6663
Mailing Address - Fax:626-939-4590
Practice Address - Street 1:14461 MERCED AVE STE 101
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5173
Practice Address - Country:US
Practice Address - Phone:626-939-4588
Practice Address - Fax:626-939-4590
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6075 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPPLIED FORMedicaid
CAAPPLIED FORMedicare UPIN
CAAPPLIED FORMedicaid