MEDICARE: DR. SUNEET GUPTA O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	CA11457T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SD0114570	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1336234814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNEET GUPTA O.D

Provider Business Mailing Address
First Line	:	3233 GRAND AVE
Second Line	:	SUITE M
City	:	CHINO HILLS
State	:	CA
Zip	:	91709
Country	:	US
Telephone Number	:	909-591-2034
Fax Number	:	909-591-2176

Provider Business Practice Location Address
First Line	:	3233 GRAND AVE
Second Line	:	SUITE M
City	:	CHINO HILLS
State	:	CA
Zip	:	91709
Country	:	US
Telephone Number	:	909-591-2034
Fax Number	:	909-591-2176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/13/2023

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