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General NPI Number Information
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NPI Number | 1477618148
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Entity Type | Individual
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Provider Name | VERNON SANFORD AGARTH JR. O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1912 W COMMONWEALTH AVE SUITE D
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City | FULLERTON
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State | CA
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Zip | 92833-3040
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Country | US
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Telephone | 714-526-1513
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Fax |
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Provider Business Mailing Address
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Address Line | 2456 CAMINO REY
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City | FULLERTON
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State | CA
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Zip | 92833-1354
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Country | US
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Telephone | 714-526-6301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 04480T
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License Number State | CA
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