Provider Demographics
NPI:1346382074
Name:A. SADEGHIAN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:A. SADEGHIAN OPTOMETRIC CORPORATION
Other - Org Name:CORONA OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROOS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:630-541-5040
Mailing Address - Street 1:1501 RIMPAU AVE
Mailing Address - Street 2:SUITE B104
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3225
Mailing Address - Country:US
Mailing Address - Phone:951-898-2010
Mailing Address - Fax:
Practice Address - Street 1:1501 RIMPAU AVE
Practice Address - Street 2:SUITE B104
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3225
Practice Address - Country:US
Practice Address - Phone:951-898-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12354T152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAER708AOtherPTAN
CAZZZ06310ZMedicare PIN