Provider Demographics
NPI:1710417522
Name:ONAGA, SARAH (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ONAGA
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 1:190 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3602
Mailing Address - Country:US
Mailing Address - Phone:714-943-2175
Mailing Address - Fax:
Practice Address - Street 1:190 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3602
Practice Address - Country:US
Practice Address - Phone:714-669-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33701TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33701TLGOtherCA OPTOMETRY LICENSE NUMBER