Provider Demographics
NPI:1114914405
Name:KAROUNA, CHANCHAI (OD)
Entity Type:Individual
Prefix:
First Name:CHANCHAI
Middle Name:
Last Name:KAROUNA
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 1:1583 VIA RONDA
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3424
Mailing Address - Country:US
Mailing Address - Phone:480-268-0937
Mailing Address - Fax:
Practice Address - Street 1:170 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071
Practice Address - Country:US
Practice Address - Phone:619-596-0589
Practice Address - Fax:619-596-0590
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11160 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162078Medicare PIN
AZZ163083Medicare PIN
AZZ162076Medicare PIN
AZZ102862Medicare PIN