Provider Demographics
NPI:1457362055
Name:SUNGA, EPIFANIO I (OD)
Entity Type:Individual
Prefix:DR
First Name:EPIFANIO
Middle Name:I
Last Name:SUNGA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 ROUTE 22 EAST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081
Mailing Address - Country:US
Mailing Address - Phone:973-376-8900
Mailing Address - Fax:973-912-9846
Practice Address - Street 1:1278 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3324
Practice Address - Country:US
Practice Address - Phone:732-505-0533
Practice Address - Fax:732-505-6572
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00604000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ27OA00604000OtherLICENSE
NJ27TO00141900OtherTPA
NJ27TO00141900OtherTPA