Healthcare Provider Details

I. General information

NPI: 1366203093
Provider Name (Legal Business Name): CHANCHAI KAROUNA OPTOMETRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 S SANDERSON AVE
HEMET CA
92545-9046
US

IV. Provider business mailing address

33132 YUCCA ST
TEMECULA CA
92592-1331
US

V. Phone/Fax

Practice location:
  • Phone: 951-766-1146
  • Fax:
Mailing address:
  • Phone: 480-268-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CHANCHAI KAROUNA
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 951-766-1146