Provider Demographics
NPI:1275197519
Name:STORCH, ANNABELLE (OD)
Entity Type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:
Last Name:STORCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92661-1528
Mailing Address - Country:US
Mailing Address - Phone:949-274-0779
Mailing Address - Fax:
Practice Address - Street 1:850 HEALTH SCIENCES RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-1528
Practice Address - Country:US
Practice Address - Phone:949-824-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008999-01152W00000X
CAOPT34243-TLG152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist