Provider Demographics
NPI:1770862393
Name:AHLUWALIA, VINEETA (OD)
Entity Type:Individual
Prefix:
First Name:VINEETA
Middle Name:
Last Name:AHLUWALIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VINEETA
Other - Middle Name:
Other - Last Name:CHADHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6755 MIRA MESA BLVD STE 141
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4311
Mailing Address - Country:US
Mailing Address - Phone:858-535-8282
Mailing Address - Fax:
Practice Address - Street 1:6755 MIRA MESA BLVD STE 141
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4311
Practice Address - Country:US
Practice Address - Phone:858-535-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14262152W00000X
TX8531TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist