Provider Demographics
NPI:1427484138
Name:SHARMA, GURU DUTT (OD)
Entity type:Individual
Prefix:DR
First Name:GURU DUTT
Middle Name:
Last Name:SHARMA
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 1:795 E 2ND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-469-8773
Mailing Address - Fax:909-469-5228
Practice Address - Street 1:5814 VAN ALLEN WAY
Practice Address - Street 2:SUITE 146
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7359
Practice Address - Country:US
Practice Address - Phone:760-421-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13675TLG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB228773OtherMEDICARE PTAN SO CAL