MEDICARE: TONNU 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	11318T	CA

General Provider Information

NPI Number	:	1790923894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TONNU OPTOMETRY INC

Provider Business Mailing Address
First Line	:	4444 EL CAJON BLVD # 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 EL CAJON BLVD # 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4312
Country	:	US
Telephone Number	:	619-280-6200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANH TONNU
Credential	:	O.D.
Telephone Number	:	619-280-6200

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	01/27/2009

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