Provider Demographics
NPI:1043350192
Name:PITLUK, SHELDON (OD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:
Last Name:PITLUK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11243 183RD ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5417
Mailing Address - Country:US
Mailing Address - Phone:562-924-0950
Mailing Address - Fax:562-809-8566
Practice Address - Street 1:11243 183RD ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5417
Practice Address - Country:US
Practice Address - Phone:562-924-0950
Practice Address - Fax:562-809-8566
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6320T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP6320Medicare ID - Type Unspecified
CAT70106Medicare UPIN