Provider Demographics
NPI:1912957507
Name:DR RICHARD A SARLITT AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:DR RICHARD A SARLITT AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SARLITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-786-7888
Mailing Address - Street 1:5327 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2938
Mailing Address - Country:US
Mailing Address - Phone:949-786-7888
Mailing Address - Fax:949-786-1817
Practice Address - Street 1:5327 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2938
Practice Address - Country:US
Practice Address - Phone:949-786-7888
Practice Address - Fax:949-786-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20018Medicare PIN
CA5630430001Medicare NSC
CAUO9561Medicare UPIN