Provider Demographics
NPI:1124216569
Name:SANGPRASIT, NUNTIDA K (OD)
Entity type:Individual
Prefix:DR
First Name:NUNTIDA
Middle Name:K
Last Name:SANGPRASIT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:SANGPRASIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3871 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5915
Mailing Address - Country:US
Mailing Address - Phone:310-375-9230
Mailing Address - Fax:310-375-9420
Practice Address - Street 1:3871 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5915
Practice Address - Country:US
Practice Address - Phone:310-375-9230
Practice Address - Fax:310-375-9420
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGV285AMedicare PIN