Provider Demographics
NPI:1700927332
Name:STEVENS-SURATT, SANDRA LYN (OD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYN
Last Name:STEVENS-SURATT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYN
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1234 W CHAPMAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2862
Mailing Address - Country:US
Mailing Address - Phone:714-997-1091
Mailing Address - Fax:714-997-1097
Practice Address - Street 1:1234 W CHAPMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2862
Practice Address - Country:US
Practice Address - Phone:714-997-1091
Practice Address - Fax:714-997-1097
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9100T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist