Provider Demographics
NPI:1124172168
Name:SORSKY, MARC ELIOT (OD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ELIOT
Last Name:SORSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 8TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-3171
Mailing Address - Country:US
Mailing Address - Phone:559-875-5524
Mailing Address - Fax:559-875-9377
Practice Address - Street 1:1329 8TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-3171
Practice Address - Country:US
Practice Address - Phone:559-875-5524
Practice Address - Fax:559-875-9377
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11217T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0112170Medicaid
CAU76742Medicare UPIN
CA6004310001Medicare NSC