=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841290475
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANDHANA SHARDA OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 02/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 291 INDEPENDENCE DR
-----------------------------------------------------
City | CHESTNUT HILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02467-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-421-1151
-----------------------------------------------------
Fax | 617-421-8787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 291 INDEPENDENCE DR
-----------------------------------------------------
City | CHESTNUT HILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02467-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-421-1151
-----------------------------------------------------
Fax | 617-421-8787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4379
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------