Healthcare Provider Details

I. General information

NPI: 1346382074
Provider Name (Legal Business Name): A. SADEGHIAN OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 RIMPAU AVE SUITE B104
CORONA CA
92881-3225
US

IV. Provider business mailing address

1501 RIMPAU AVE SUITE B104
CORONA CA
92881-3225
US

V. Phone/Fax

Practice location:
  • Phone: 951-898-2010
  • Fax:
Mailing address:
  • Phone: 951-898-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number12354T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number12354T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number12354T
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12354T
License Number StateCA

VIII. Authorized Official

Name: BARBARA A ROOS
Title or Position: BILLING MANAGER
Credential: CPC
Phone: 630-541-5040