Provider Demographics
NPI:1841851045
Name:THIAGARAJAN, PREETHI (OD, PHD, FAAO)
Entity type:Individual
Prefix:DR
First Name:PREETHI
Middle Name:
Last Name:THIAGARAJAN
Suffix:
Gender:F
Credentials:OD, PHD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15051 HESPERIAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3536
Mailing Address - Country:US
Mailing Address - Phone:646-330-9068
Mailing Address - Fax:
Practice Address - Street 1:15051 HESPERIAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3536
Practice Address - Country:US
Practice Address - Phone:646-330-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5378152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty