Provider Demographics
NPI:1124195789
Name:KALRA, ANKUR (OD)
Entity Type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:
Last Name:KALRA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 TROVITA DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8714
Mailing Address - Country:US
Mailing Address - Phone:951-280-0802
Mailing Address - Fax:
Practice Address - Street 1:1481 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3613
Practice Address - Country:US
Practice Address - Phone:619-477-2159
Practice Address - Fax:619-477-2128
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11898T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0118980Medicaid
CAU91189Medicare UPIN
CAW19760Medicare PIN