Provider Demographics
NPI:1174730824
Name:TILLMAN, SYLVIA ELISE (OD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:ELISE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SYLVIA
Other - Middle Name:ELISE
Other - Last Name:SHENHAV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1521 LINDA SUE LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2424
Mailing Address - Country:US
Mailing Address - Phone:760-634-7699
Mailing Address - Fax:760-634-7699
Practice Address - Street 1:1521 LINDA SUE LN
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2424
Practice Address - Country:US
Practice Address - Phone:760-634-7699
Practice Address - Fax:760-634-7699
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9726T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP9726AMedicare ID - Type Unspecified
U94828Medicare UPIN