MEDICARE: PACIFICA SUN OPTOMETRY INC

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

General Provider Information

NPI Number	:	1346074994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFICA SUN OPTOMETRY INC

Provider Business Mailing Address
First Line	:	2014 PALMETTO AVE STE B
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-2796
Country	:	US
Telephone Number	:	650-359-2231
Fax Number	:	650-359-2305

Provider Business Practice Location Address
First Line	:	2014 PALMETTO AVE STE B
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-2796
Country	:	US
Telephone Number	:	650-359-2231
Fax Number	:	650-359-2305

Authorized Official
Title or Position	:	OWNER
Name	:	SOPHIA SUN
Credential	:	OD
Telephone Number	:	650-359-2231

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	12/31/2024

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Directions to “PACIFICA SUN OPTOMETRY INC ” Practice Location

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