Vernon Sanford Agarth Jr., O.D.
Individual provider Active NPI Optometrist · Fullerton, CA
NPI 1477618148 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1477618148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 04480T (CA)
- Practice address
- 1912 W Commonwealth Ave
Suite D
Fullerton, CA 92833-3040 - Phone
- (714) 526-1513
- NPI assigned
- Dec 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04480T | CA | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 04480T | CA | Yes |
Addresses
Primary practice location
1912 W Commonwealth Ave
Suite D
Fullerton, CA 92833-3040
Mailing address
2456 Camino Rey
Fullerton, CA 92833-1354
Phone (714) 526-6301
Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.