=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366203093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHANCHAI KAROUNA OPTOMETRY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2024
-----------------------------------------------------
Last Update Date | 01/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1231 S SANDERSON AVE
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92545-9046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-766-1146
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33132 YUCCA ST
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92592-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-268-0937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/OWNER
-----------------------------------------------------
Name | CHANCHAI KAROUNA
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 951-766-1146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------