Provider Demographics
NPI:1376876227
Name:KANJIYA, NIRVIGHNA N (OD)
Entity Type:Individual
Prefix:DR
First Name:NIRVIGHNA
Middle Name:N
Last Name:KANJIYA
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 1:9200 MILLIKEN AVE
Mailing Address - Street 2:#9215
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5484
Mailing Address - Country:US
Mailing Address - Phone:248-736-2138
Mailing Address - Fax:
Practice Address - Street 1:2001 S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5228
Practice Address - Country:US
Practice Address - Phone:252-633-6900
Practice Address - Fax:252-633-6754
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002286152W00000X
CA14589152W00000X
NC2508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist