Provider Demographics
NPI:1174907976
Name:SULJUKI, LAHEQA (OD)
Entity type:Individual
Prefix:DR
First Name:LAHEQA
Middle Name:
Last Name:SULJUKI
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 1:1640 CAMINO DEL RIO N.
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-299-3113
Mailing Address - Fax:619-299-0766
Practice Address - Street 1:1640 CAMINO DEL RIO N.
Practice Address - Street 2:STE. 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-299-3113
Practice Address - Fax:619-299-0766
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2050152W00000X
CA33411-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist