Provider Demographics
NPI:1215361597
Name:DR GLORIA SURH PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:DR GLORIA SURH PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:IDEAL EYES OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-347-2200
Mailing Address - Street 1:1403 BURLINGAME AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4110
Mailing Address - Country:US
Mailing Address - Phone:415-347-2200
Mailing Address - Fax:
Practice Address - Street 1:1403 BURLINGAME AVE
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4110
Practice Address - Country:US
Practice Address - Phone:415-347-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127342T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty