Healthcare Provider Details

I. General information

NPI: 1275197519
Provider Name (Legal Business Name): ANNABELLE STORCH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/25/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HEALTH SCIENCES RD
IRVINE CA
92697-1528
US

IV. Provider business mailing address

421 SEVILLE AVE
NEWPORT BEACH CA
92661-1528
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-2020
  • Fax:
Mailing address:
  • Phone: 949-274-0779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008999-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT34243-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: