Provider Demographics
NPI:1316177868
Name:SINCLAIR, TISHA (RDO)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 MING AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-4139
Mailing Address - Country:US
Mailing Address - Phone:661-834-0400
Mailing Address - Fax:661-834-0406
Practice Address - Street 1:3216 MING AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4139
Practice Address - Country:US
Practice Address - Phone:661-834-0400
Practice Address - Fax:661-834-0406
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5677156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician