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General NPI Number Information
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NPI Number | 1851604540
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Entity Type | Individual
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Provider Name | VIDENNE SATH O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 3412 COLLEGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-7134
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Country | US
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Telephone | 619-286-1291
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Fax |
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Provider Business Mailing Address
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Address Line | 3634 OLD COBBLE RD
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City | SAN DIEGO
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State | CA
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Zip | 92111-4048
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Country | US
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Telephone | 562-895-1684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14102
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License Number State | CA
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