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General NPI Number Information
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NPI Number | 1578289344
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Entity Type | Individual
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Provider Name | JUSTIN SUN OPT
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Gender | Male
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 7700 ORANGETHORPE AVE STE 6
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City | BUENA PARK
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State | CA
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Zip | 90621-3476
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Country | US
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Telephone | 714-766-5767
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 ORANGETHORPE AVE STE 6
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City | BUENA PARK
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State | CA
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Zip | 90621-3476
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Country | US
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Telephone | 714-766-5767
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 215012
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License Number State | CA
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