Vacharkulksemsuk, Tara

Vacharkulksemsuk, Tara is an individual health care provider with primary practice located at 32245 Mission Trl Ste D4 , Lake Elsinore CA 92530-4528. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Vacharkulksemsuk, Tara can be contacted via phone (951) 674-1561.

Contact Information

Primary practice address
32245 Mission Trl Ste D4 Lake Elsinore CA 92530-4528
Phone: (951) 674-1561
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 13949 California

Profile Details

NPI number 1588977938
LBN Legal business name Vacharkulksemsuk, Tara
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2010
Last updated Nov 30th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588977938 NPPES
Texas MEDICAID 112409104
Texas MEDICAID 283028301

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