Individual provider · NPI-1

Khyristienne Clark

Technician/Technologist, Optometric Technician · Los Angeles, CA

NPI number1881574382
StatusActive
Last updated in NPPESSep 4, 2025

Details

NPI
1881574382
Entity type
Individual (NPI-1)
Name
Khyristienne Clark
Sex
Female
Sole proprietor
Yes
Enumeration date
Sep 4, 2025
Certification date
Sep 4, 2025
Last updated
Sep 4, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
156FX1202X Technician/Technologist, Optometric Technician–CAYes

Practice location

11301 Wilshire Blvd Bldg 304
Los Angeles, CA 90073-1003

Phone 310-478-3711

Mailing address

9636 S Harvard Blvd
Los Angeles, CA 90047-3814

Phone 747-295-3999

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