Provider Demographics
NPI:1558050971
Name:KAMALESWARAN, VINOJA (OD)
Entity Type:Individual
Prefix:
First Name:VINOJA
Middle Name:
Last Name:KAMALESWARAN
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 1:200 BRANNAN ST APT 404
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-6012
Mailing Address - Country:US
Mailing Address - Phone:925-744-1553
Mailing Address - Fax:
Practice Address - Street 1:451 S AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-6909
Practice Address - Country:US
Practice Address - Phone:650-589-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist