Provider Demographics
NPI:1033227665
Name:SHARIEFF, KAUSER V (OD FCOVD)
Entity Type:Individual
Prefix:DR
First Name:KAUSER
Middle Name:V
Last Name:SHARIEFF
Suffix:
Gender:F
Credentials:OD FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17674 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3927
Mailing Address - Country:US
Mailing Address - Phone:714-996-6210
Mailing Address - Fax:714-996-6212
Practice Address - Street 1:17674 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3927
Practice Address - Country:US
Practice Address - Phone:714-996-6210
Practice Address - Fax:714-996-6212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10527152W00000X, 152WV0400X, 152WL0500X, 152WP0200X
CA10527TPL152WL0500X
MO10527152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD10527Medicaid
CASD10527Medicaid