Provider Demographics
NPI:1780694430
Name:KEDDINGTON & KALRA OPTOMETRISTS APC
Entity type:Organization
Organization Name:KEDDINGTON & KALRA OPTOMETRISTS APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KALRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-477-2159
Mailing Address - Street 1:1481 E PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3613
Mailing Address - Country:US
Mailing Address - Phone:619-477-2159
Mailing Address - Fax:619-477-2128
Practice Address - Street 1:1481 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3613
Practice Address - Country:US
Practice Address - Phone:619-477-2159
Practice Address - Fax:619-477-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR1150152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19760OtherMEDICARE GROUP PIN
CAGSD004450Medicaid
CAGSD004450Medicaid
CAY53909Medicare UPIN