Provider Demographics
NPI:1114201852
Name:SUNNER BASI, AMANJOT (OD)
Entity type:Individual
Prefix:DR
First Name:AMANJOT
Middle Name:
Last Name:SUNNER BASI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANJOT
Other - Middle Name:KAUR
Other - Last Name:SUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2575 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1615
Mailing Address - Country:US
Mailing Address - Phone:714-449-7428
Mailing Address - Fax:714-992-7846
Practice Address - Street 1:2575 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1615
Practice Address - Country:US
Practice Address - Phone:714-449-7428
Practice Address - Fax:714-992-7846
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist