Healthcare Provider Details

I. General information

NPI: 1346074994
Provider Name (Legal Business Name): PACIFICA SUN OPTOMETRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 PALMETTO AVE STE B
PACIFICA CA
94044-2796
US

IV. Provider business mailing address

2014 PALMETTO AVE STE B
PACIFICA CA
94044-2796
US

V. Phone/Fax

Practice location:
  • Phone: 650-359-2231
  • Fax: 650-359-2305
Mailing address:
  • Phone: 650-359-2231
  • Fax: 650-359-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SOPHIA SUN
Title or Position: OWNER
Credential: OD
Phone: 650-359-2231