Provider Demographics
NPI:1073974366
Name:CLARISSA SIN OD, INC
Entity Type:Organization
Organization Name:CLARISSA SIN OD, INC
Other - Org Name:DRS IN OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-896-9982
Mailing Address - Street 1:2918 SORRENTO WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 N SAN MATEO DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2708
Practice Address - Country:US
Practice Address - Phone:650-344-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARISSA SIN OD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-14
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty