Provider Demographics
NPI:1346231305
Name:SARNO, THERESA AGUSTIN (OD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:AGUSTIN
Last Name:SARNO
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 1:6225W 87TH ST 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3952
Mailing Address - Country:US
Mailing Address - Phone:310-674-5123
Mailing Address - Fax:310-674-1966
Practice Address - Street 1:6225W 87TH ST 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3952
Practice Address - Country:US
Practice Address - Phone:310-674-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12856T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist