Provider Demographics
NPI:1962043463
Name:VILLA, SHARON (OD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:VILLA
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 1:2746 BAL HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-3404
Mailing Address - Country:US
Mailing Address - Phone:510-754-5438
Mailing Address - Fax:
Practice Address - Street 1:1613 LOCUST ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4118
Practice Address - Country:US
Practice Address - Phone:925-765-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34415TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist