Provider Demographics
NPI:1780836080
Name:JA, SYLVIA (OD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:JA
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 1:21465 MILLARD LN
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1320
Mailing Address - Country:US
Mailing Address - Phone:408-735-8522
Mailing Address - Fax:
Practice Address - Street 1:21465 MILLARD LN
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1320
Practice Address - Country:US
Practice Address - Phone:408-735-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist