Healthcare Provider Details

I. General information

NPI: 1710804596
Provider Name (Legal Business Name): SABRINA THENG SARUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7841 MALL RD STE 100
FLORENCE KY
41042-1439
US

IV. Provider business mailing address

50 W RIVERCENTER BLVD APT 804
COVINGTON KY
41011-2444
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-8810
  • Fax:
Mailing address:
  • Phone: 813-708-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2493DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: