Provider Demographics
NPI:1801440235
Name:MISSION VALLEY FAMILY OPTOMETRY
Entity type:Organization
Organization Name:MISSION VALLEY FAMILY OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAHEQA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULJUKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-299-3113
Mailing Address - Street 1:1640 CAMINO DEL RIO N STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1523
Mailing Address - Country:US
Mailing Address - Phone:619-299-3113
Mailing Address - Fax:619-299-0766
Practice Address - Street 1:1640 CAMINO DEL RIO N STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1523
Practice Address - Country:US
Practice Address - Phone:619-299-3113
Practice Address - Fax:619-299-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty