Provider Demographics
NPI:1376682542
Name:BHUTANI, VASUDHA (OD)
Entity Type:Individual
Prefix:
First Name:VASUDHA
Middle Name:
Last Name:BHUTANI
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 1:6345 BALBOA BLVD
Mailing Address - Street 2:BLDG 3, SUITE 250
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1519
Mailing Address - Country:US
Mailing Address - Phone:818-344-3937
Mailing Address - Fax:818-344-1229
Practice Address - Street 1:6345 BALBOA BLVD
Practice Address - Street 2:BLDG 3, SUITE 250
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1519
Practice Address - Country:US
Practice Address - Phone:818-344-3937
Practice Address - Fax:818-344-1229
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAME1525142152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16162Medicare UPIN