MEDICARE: SUNEET K GUPTA 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	11457 TPL	CA

General Provider Information

NPI Number	:	1902120488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNEET K GUPTA INC

Provider Business Mailing Address
First Line	:	3233 GRAND AVE
Second Line	:	SUITE M
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1489
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	:	91709-1489
Country	:	US
Telephone Number	:	909-591-2034
Fax Number	:	909-591-2176

Authorized Official
Title or Position	:	OWNER
Name	:	SUNEET GUPTA
Credential	:	OD
Telephone Number	:	909-591-2034

Provider Enumeration Date	:	03/26/2010
Last Update Date	:	03/13/2023

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