Provider Demographics
NPI:1932883519
Name:HEMACHANDRA, DILINI T (OD)
Entity Type:Individual
Prefix:MISS
First Name:DILINI
Middle Name:T
Last Name:HEMACHANDRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:DILINI
Other - Middle Name:T
Other - Last Name:HEMACHANDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:825 E BIDWELL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4207
Mailing Address - Country:US
Mailing Address - Phone:279-202-1205
Mailing Address - Fax:
Practice Address - Street 1:825 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4207
Practice Address - Country:US
Practice Address - Phone:279-202-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35454-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist