Provider Demographics
NPI:1952940702
Name:TUSTIN OPTOMETRIC CENTER, INC
Entity Type:Organization
Organization Name:TUSTIN OPTOMETRIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:SUN
Authorized Official - Last Name:KAME
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:213-357-2025
Mailing Address - Street 1:4181 EUREKA AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2390 N TUSTIN AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1657
Practice Address - Country:US
Practice Address - Phone:714-543-3167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty