Healthcare Provider Details

I. General information

NPI: 1144077892
Provider Name (Legal Business Name): TREY MASARU SANO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 SKYLAR LN
CLOVIS CA
93619-6942
US

IV. Provider business mailing address

1029 SKYLAR LN
CLOVIS CA
93619-6942
US

V. Phone/Fax

Practice location:
  • Phone: 714-449-7400
  • Fax:
Mailing address:
  • Phone: 559-355-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: