Provider Demographics
NPI:1104807809
Name:VANSUCH, JOSEPH J III (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:VANSUCH
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 E KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-4860
Mailing Address - Country:US
Mailing Address - Phone:714-997-3535
Mailing Address - Fax:714-771-4870
Practice Address - Street 1:128 E KATELLA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-4836
Practice Address - Country:US
Practice Address - Phone:714-997-3535
Practice Address - Fax:714-771-4870
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6373TPL152WC0802X
CA6373TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330839978OtherVISION SERVICE PLAN
CAU-26407Medicare UPIN