Healthcare Provider Details

I. General information

NPI: 1659064335
Provider Name (Legal Business Name): VYOMA SHINDE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W FREMONT AVE
SUNNYVALE CA
94087-3000
US

IV. Provider business mailing address

633 HIDDEN LAKES DR
MARTINEZ CA
94553-5417
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-6200
  • Fax:
Mailing address:
  • Phone: 925-812-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number35466
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number35466
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number35466
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number35466
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number35466
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number35466
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: