Provider Demographics
NPI:1225002686
Name:SHLYAKHOV, EUGENE D (OD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:D
Last Name:SHLYAKHOV
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OAK ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2016
Mailing Address - Country:US
Mailing Address - Phone:916-802-8172
Mailing Address - Fax:
Practice Address - Street 1:701 HOWE AVE
Practice Address - Street 2:SUITE G-48
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4670
Practice Address - Country:US
Practice Address - Phone:916-921-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7056T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU75452Medicare UPIN
CABZ795ZMedicare PIN