Provider Demographics
NPI:1952707218
Name:GURU DUTT SHARMA, OD A PROFESSIONAL OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:GURU DUTT SHARMA, OD A PROFESSIONAL OPTOMETRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GURU DUTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PHD
Authorized Official - Phone:760-421-6507
Mailing Address - Street 1:528 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4008
Mailing Address - Country:US
Mailing Address - Phone:619-456-2371
Mailing Address - Fax:
Practice Address - Street 1:528 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4008
Practice Address - Country:US
Practice Address - Phone:619-456-2371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427484138OtherINDIVIDUAL NPI FOR DR GURU DUTT SHARMA