Active NPI
Sutera Nudtavuthtisit, DOCTOR OF OPTOMETRY
- Optometrist
- Fullerton, CA
National Provider Identifier
1770969701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 15263 TLG
- Practice address
- 1319 S Harbor Blvd
Fullerton, CA 92832-3001 - Phone
- (714) 525-3330
- Fax
- (714) 525-3334
- NPI assigned
- Jul 31, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 15263 TLG | CA | Primary |
Addresses
Primary practice location
1319 S Harbor Blvd
Fullerton, CA 92832-3001
Mailing address
2629 E Brookside Ave
Orange, CA 92867-4008
Phone (949) 463-6817
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15263 TLG | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479168000000",
"number": "1770969701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2629 E BROOKSIDE AVE",
"city": "ORANGE",
"state": "CA",
"postal_code": "928674008",
"telephone_number": "949-463-6817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1319 S HARBOR BLVD",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928323001",
"telephone_number": "714-525-3330",
"fax_number": "714-525-3334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUDTAVUTHTISIT",
"first_name": "SUTERA",
"credential": "DOCTOR OF OPTOMETRY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-31",
"last_updated": "2016-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "15263 TLG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.