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General NPI Number Information
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NPI Number | 1134360563
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Entity Type | Organization
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Legal Business Name | VANSUCH OPTOMETRIC, INC.
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Dates
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Enumeration Date | 03/15/2009
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Last Update Date | 03/15/2009
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Provider Practice Location Address
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Address Line | 128 E KATELLA AVE STE 100
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City | ORANGE
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State | CA
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Zip | 92867-4850
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Country | US
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Telephone | 714-997-3535
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Fax | 714-771-4870
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Provider Business Mailing Address
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Address Line | 128 E KATELLA AVE STE 100
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City | ORANGE
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State | CA
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Zip | 92867-4850
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Country | US
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Telephone | 714-997-3535
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Fax | 714-771-4870
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH J VANSUCH
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Credential | O.D.
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Telephone | 714-997-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 6373T
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License Number State | CA
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