Healthcare Provider Details

I. General information

NPI: 1114478997
Provider Name (Legal Business Name): SUKIASSIANS OPTOMETRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 TAMPA AVE
NORTHRIDGE CA
91324-3524
US

IV. Provider business mailing address

9027 TAMPA AVE
NORTHRIDGE CA
91324-3524
US

V. Phone/Fax

Practice location:
  • Phone: 818-349-7617
  • Fax:
Mailing address:
  • Phone: 818-349-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12246-T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number12246-T
License Number StateCA

VIII. Authorized Official

Name: DR. CHRIS KARLOS SUKIASSIANS
Title or Position: PRESIDENT/OPTOMETRIST
Credential: O.D.
Phone: 818-203-7123