Healthcare Provider Details

I. General information

NPI: 1265682876
Provider Name (Legal Business Name): NATHAN H SCHRAMM O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NATHAN JAMES SANDERSON

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE M3
COSTA MESA CA
92626-4626
US

IV. Provider business mailing address

3151 AIRWAY AVE STE M3
COSTA MESA CA
92626-4626
US

V. Phone/Fax

Practice location:
  • Phone: 714-486-3315
  • Fax: 714-486-3071
Mailing address:
  • Phone: 714-486-3315
  • Fax: 714-486-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4407
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number34766-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: