Provider Demographics
NPI:1154312916
Name:SUN, IVY KAREN (OD)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:KAREN
Last Name:SUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4741
Mailing Address - Country:US
Mailing Address - Phone:925-275-0202
Mailing Address - Fax:925-275-0447
Practice Address - Street 1:175 MARKET PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4741
Practice Address - Country:US
Practice Address - Phone:925-275-0202
Practice Address - Fax:925-275-0447
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10943T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0109430Medicare ID - Type Unspecified
U71482Medicare UPIN