Healthcare Provider Details

I. General information

NPI: 1740102730
Provider Name (Legal Business Name): SUREKA SUNTHARAVEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CROSSINGS RD
SANDUSKY OH
44870-8913
US

IV. Provider business mailing address

176 CHEROKEE DRIVE
VAUGHAN ON
L6A2M7
CA

V. Phone/Fax

Practice location:
  • Phone: 419-626-5148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: