Provider Demographics
NPI:1821498387
Name:EYE ZONE OPTOMETRY, INC.
Entity Type:Organization
Organization Name:EYE ZONE OPTOMETRY, INC.
Other - Org Name:NUNTIDA KATHY SANGPRASIT, O.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST/OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NUNTIDA
Authorized Official - Middle Name:KATHY
Authorized Official - Last Name:SANGPRASIT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-375-9230
Mailing Address - Street 1:3871 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3871 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5915
Practice Address - Country:US
Practice Address - Phone:310-375-9230
Practice Address - Fax:310-375-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124216569Medicaid