Provider Demographics
NPI:1043883192
Name:MASHIANA OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:MASHIANA OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHIANA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-935-8540
Mailing Address - Street 1:PO BOX 1707
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92033-1707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1923 CALLE BARCELONA STE 139B
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8457
Practice Address - Country:US
Practice Address - Phone:510-935-8540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty