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General NPI Number Information
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NPI Number | 1295090579
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Entity Type | Organization
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Legal Business Name | SULKYUNG NA OPTOMETRY INC
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 431 E 1ST ST STE 4B
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City | SANTA ANA
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State | CA
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Zip | 92701-5303
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Country | US
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Telephone | 714-564-0760
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Fax | 714-564-0747
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Provider Business Mailing Address
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Address Line | 431 E 1ST ST STE 4B
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City | SANTA ANA
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State | CA
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Zip | 92701-5303
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Country | US
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Telephone | 714-564-0760
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Fax | 714-564-0747
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SULKYUNG J NA
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Credential | OD
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Telephone | 714-564-0760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11542T
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License Number State | CA
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