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General NPI Number Information
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NPI Number | 1518499987
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Entity Type | Organization
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Legal Business Name | SARIYA VORASARUN OD, INC
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 11525 SOUTH ST
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City | CERRITOS
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State | CA
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Zip | 90703-6627
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Country | US
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Telephone | 562-402-1115
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Fax | 562-402-1116
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Provider Business Mailing Address
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Address Line | 11140 NOEL ST
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3780
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Country | US
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Telephone | 310-989-1052
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Fax | 564-402-1116
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SARIYA VORASARUN
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Credential | OD
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Telephone | 310-989-1052
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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 | 11403TLG
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License Number State | CA
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