1790423580 NPI number — THE LIGHT FOR SENIORS, INC.

Table of content: DR. KAYLIA SORGIE OD OPTOMETRIST (NPI 1881325157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790423580 NPI number — THE LIGHT FOR SENIORS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LIGHT FOR SENIORS, 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:
6
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:
1790423580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3405 KENYON ST STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92110-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-751-0752
Provider Business Mailing Address Fax Number:
888-308-9223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3405 KENYON ST STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-751-0752
Provider Business Practice Location Address Fax Number:
888-308-9223
Provider Enumeration Date:
05/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
COSTA-SMITH
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
858-751-0752

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1790423580 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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