Provider Demographics
NPI:1922154954
Name:SMITHSUVAN, SANTI (OD)
Entity Type:Individual
Prefix:MR
First Name:SANTI
Middle Name:
Last Name:SMITHSUVAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 SKYPARK DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5351
Mailing Address - Country:US
Mailing Address - Phone:310-539-7100
Mailing Address - Fax:310-539-7121
Practice Address - Street 1:2751 SKYPARK DR
Practice Address - Street 2:TORRANCE COSTCO
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5351
Practice Address - Country:US
Practice Address - Phone:310-539-7100
Practice Address - Fax:310-539-7121
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9787T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist