Provider Demographics
NPI:1255176731
Name:SUN, CALVIN (OD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:SUN
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 1:18812 BELSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8410
Mailing Address - Country:US
Mailing Address - Phone:619-430-0577
Mailing Address - Fax:
Practice Address - Street 1:46660 WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2451
Practice Address - Country:US
Practice Address - Phone:760-564-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist