Provider Demographics
NPI:1336234814
Name:GUPTA, SUNEET (OD)
Entity Type:Individual
Prefix:DR
First Name:SUNEET
Middle Name:
Last Name:GUPTA
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 1:3233 GRAND AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709
Mailing Address - Country:US
Mailing Address - Phone:909-591-2034
Mailing Address - Fax:909-591-2176
Practice Address - Street 1:3233 GRAND AVE
Practice Address - Street 2:SUITE M
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709
Practice Address - Country:US
Practice Address - Phone:909-591-2034
Practice Address - Fax:909-591-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11457T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114570OtherMEDI-CAL
CAU88370Medicare UPIN
CACX907ZMedicare PIN