Provider Demographics
NPI:1164863544
Name:SUD, RAHUL RAJENDRA (OD)
Entity type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:RAJENDRA
Last Name:SUD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4004
Mailing Address - Country:US
Mailing Address - Phone:415-874-4332
Mailing Address - Fax:415-561-9957
Practice Address - Street 1:2100 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4004
Practice Address - Country:US
Practice Address - Phone:415-874-4332
Practice Address - Fax:415-561-9957
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002825152W00000X
CA15451TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist