Provider Demographics
NPI:1457432379
Name:BATRA, VINEET NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:VINEET
Middle Name:NICHOLAS
Last Name:BATRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:V.
Other - Middle Name:NICHOLAS
Other - Last Name:BATRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:15051 HESPERIAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3536
Mailing Address - Country:US
Mailing Address - Phone:510-357-3636
Mailing Address - Fax:510-357-3391
Practice Address - Street 1:15051 HESPERIAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3536
Practice Address - Country:US
Practice Address - Phone:510-357-3636
Practice Address - Fax:510-357-3391
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62852207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62852OtherLICSENCE
CA00A628521Medicaid
CA00A628521Medicaid
CA00A628520Medicare ID - Type Unspecified