Provider Demographics
NPI:1134185796
Name:KACHALIA, NIYO RAMANIKLAL (OD)
Entity type:Individual
Prefix:
First Name:NIYO
Middle Name:RAMANIKLAL
Last Name:KACHALIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NIYO
Other - Middle Name:RAMANIKLAL
Other - Last Name:AURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:835 CANADA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035
Mailing Address - Country:US
Mailing Address - Phone:408-768-9177
Mailing Address - Fax:
Practice Address - Street 1:904 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-426-1050
Practice Address - Fax:831-423-1050
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10122T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0101221Medicare ID - Type Unspecified
CAU48178Medicare UPIN