Provider Demographics
NPI:1770633380
Name:LAUREN, SUAREE (OD)
Entity Type:Individual
Prefix:
First Name:SUAREE
Middle Name:
Last Name:LAUREN
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 1:951 SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-2766
Mailing Address - Country:US
Mailing Address - Phone:562-697-6597
Mailing Address - Fax:562-947-9897
Practice Address - Street 1:16152 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2527
Practice Address - Country:US
Practice Address - Phone:562-947-0346
Practice Address - Fax:562-947-9897
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU59490Medicare UPIN
CAWOP10506Medicare ID - Type Unspecified