Provider Demographics
NPI:1245445303
Name:SURH, GLORIA (OD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:SURH
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 1:1365 GREEN ST
Mailing Address - Street 2:301
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-1929
Mailing Address - Country:US
Mailing Address - Phone:415-341-2772
Mailing Address - Fax:
Practice Address - Street 1:1403 BURLINGAME AVE
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4110
Practice Address - Country:US
Practice Address - Phone:650-347-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12732-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist