Provider Demographics
NPI:1952060873
Name:ST ONGE, CORAL YVONNE (OD)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:YVONNE
Last Name:ST ONGE
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 1:848 LOGANBERRY CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-1845
Mailing Address - Country:US
Mailing Address - Phone:760-845-3001
Mailing Address - Fax:
Practice Address - Street 1:225 E 2ND AVE STE 310
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4244
Practice Address - Country:US
Practice Address - Phone:760-738-9985
Practice Address - Fax:800-838-2695
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT34914-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist