Provider Demographics
NPI:1598922064
Name:ANTHONY SORIA OD INC
Entity Type:Organization
Organization Name:ANTHONY SORIA OD INC
Other - Org Name:HEALDSBURG OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SORIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-433-5020
Mailing Address - Street 1:640 HEALDSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3609
Mailing Address - Country:US
Mailing Address - Phone:707-433-5020
Mailing Address - Fax:707-433-2350
Practice Address - Street 1:640 HEALDSBURG AVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3609
Practice Address - Country:US
Practice Address - Phone:707-433-5020
Practice Address - Fax:707-433-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9925T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0099250Medicaid
CAZZZ25192ZMedicare PIN
CASD0099250Medicaid