Provider Demographics
NPI:1881148179
Name:SORACCO, KAITLIN ANNE (OD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANNE
Last Name:SORACCO
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 1:1700 BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7941
Mailing Address - Country:US
Mailing Address - Phone:530-891-1900
Mailing Address - Fax:530-895-1664
Practice Address - Street 1:320 H ST STE 4
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5834
Practice Address - Country:US
Practice Address - Phone:530-743-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33495-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist