1518499987 NPI number — SARIYA VORASARUN OD, INC

Table of content: (NPI 1518499987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518499987 NPI number — SARIYA VORASARUN OD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARIYA VORASARUN OD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518499987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11140 NOEL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALAMITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90720-3780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-989-1052
Provider Business Mailing Address Fax Number:
564-402-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11525 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CERRITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90703-6627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-402-1115
Provider Business Practice Location Address Fax Number:
562-402-1116
Provider Enumeration Date:
04/03/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VORASARUN
Authorized Official First Name:
SARIYA
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
310-989-1052

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  11403TLG , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)