Provider Demographics
NPI:1922048537
Name:JOSHI, KETUL (OD)
Entity Type:Individual
Prefix:DR
First Name:KETUL
Middle Name:
Last Name:JOSHI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 HOPYARD RD STE F1
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2772
Mailing Address - Country:US
Mailing Address - Phone:925-227-0400
Mailing Address - Fax:925-227-0730
Practice Address - Street 1:4825 HOPYARD RD STE F1
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2772
Practice Address - Country:US
Practice Address - Phone:925-227-0400
Practice Address - Fax:925-227-0730
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12154152W00000X
CA12154TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMJ0979180OtherDEA
CAMT0646010OtherDEA
CASD0014000Medicare ID - Type Unspecified
CAMJ0979180OtherDEA
CASD0121540Medicare PIN
CAMT0646010OtherDEA