Provider Demographics
NPI:1639341399
Name:SUNDARAM, SEEMA VISHNU (MD)
Entity Type:Individual
Prefix:DR
First Name:SEEMA
Middle Name:VISHNU
Last Name:SUNDARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SEEMA
Other - Middle Name:
Other - Last Name:VISHNU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E PALOMAR ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1800
Mailing Address - Country:US
Mailing Address - Phone:619-397-3088
Mailing Address - Fax:
Practice Address - Street 1:1400 E PALOMAR ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1800
Practice Address - Country:US
Practice Address - Phone:619-397-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125017207W00000X, 207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology