Provider Demographics
NPI:1447611181
Name:SUNGA, LORRAINE S (OD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:S
Last Name:SUNGA
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 1:302 ROUTE 4 STE 105
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-4301
Mailing Address - Country:US
Mailing Address - Phone:671-475-8090
Mailing Address - Fax:
Practice Address - Street 1:302 ROUTE 4 STE 105
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-4301
Practice Address - Country:US
Practice Address - Phone:671-475-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUOL-036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist