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General NPI Number Information
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NPI Number | 1679985048
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Entity Type | Organization
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Legal Business Name | SUNRISE OPTOMETRY INC
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 12435 LIMONITE AVE SUITE 560
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City | EASTVALE
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State | CA
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Zip | 91752-2455
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Country | US
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Telephone | 951-681-2816
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Fax | 951-685-6866
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Provider Business Mailing Address
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Address Line | 12435 LIMONITE AVE SUITE 560
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City | EASTVALE
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State | CA
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Zip | 91752-2455
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Country | US
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Telephone | 951-681-2816
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Fax | 951-685-6866
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | VINNIE TIEU
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Credential |
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Telephone | 951-681-2816
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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 | 11758T
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License Number State | CA
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