Provider Demographics
NPI:1497808620
Name:KAMATH, SANDYA MADHU (OD)
Entity Type:Individual
Prefix:
First Name:SANDYA
Middle Name:MADHU
Last Name:KAMATH
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 1:1800 HARRISON ST
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:510-625-5356
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:395 CIVIC DR
Practice Address - Street 2:STE G
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1979
Practice Address - Country:US
Practice Address - Phone:925-676-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00133600152W00000X
CA12144T152W00000X
NJ27OA00665700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99326Medicare UPIN