Provider Demographics
NPI:1407121239
Name:RATRA, SHILPI (OD)
Entity type:Individual
Prefix:
First Name:SHILPI
Middle Name:
Last Name:RATRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34485 RAINDEER CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3304
Mailing Address - Country:US
Mailing Address - Phone:530-220-4447
Mailing Address - Fax:
Practice Address - Street 1:130 S SUNNYVALE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6249
Practice Address - Country:US
Practice Address - Phone:408-736-3802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14482152W00000X
AZ1830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist