Provider Demographics
NPI:1699113258
Name:SWEETNAM, ELIZABETH C (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:C
Last Name:SWEETNAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:C
Other - Last Name:NEWCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38707 STIVERS ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5337
Mailing Address - Country:US
Mailing Address - Phone:510-794-0660
Mailing Address - Fax:510-793-5044
Practice Address - Street 1:38707 STIVERS ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5337
Practice Address - Country:US
Practice Address - Phone:510-794-0660
Practice Address - Fax:510-793-5044
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist