Provider Demographics
NPI:1780038745
Name:DR SHELDON B PITLUK, OPTOMETRIST, PC
Entity Type:Organization
Organization Name:DR SHELDON B PITLUK, OPTOMETRIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:PITLUK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-924-0950
Mailing Address - Street 1:11243 183RD ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5417
Mailing Address - Country:US
Mailing Address - Phone:562-924-0950
Mailing Address - Fax:
Practice Address - Street 1:11243 183RD ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5417
Practice Address - Country:US
Practice Address - Phone:562-924-0950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6320T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty