Provider Demographics
NPI:1902629652
Name:VARSHA MATHUR OPTOMETRIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:VARSHA MATHUR OPTOMETRIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-979-7335
Mailing Address - Street 1:149 E ELKHORN AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9172
Mailing Address - Country:US
Mailing Address - Phone:909-979-7335
Mailing Address - Fax:
Practice Address - Street 1:3749 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8000
Practice Address - Country:US
Practice Address - Phone:559-733-9966
Practice Address - Fax:559-318-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800348258Medicaid