MEDICARE: ANISHA N. RAVAL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001038	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7985500	OTHER		AETNA
2	RA1449088	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1801978523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANISHA N. RAVAL O.D.

Provider Business Mailing Address
First Line	:	RAVAL EYE CARE ASSOCIATES
Second Line	:	1495 OLD YORK ROAD
City	:	ABINGTON
State	:	PA
Zip	:	19001-1923
Country	:	US
Telephone Number	:	215-572-6098
Fax Number	:	215-572-6308

Provider Business Practice Location Address
First Line	:	2329 COTTMAN AVE
Second Line	:	ROOSEVELT MALL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1003
Country	:	US
Telephone Number	:	215-332-7228
Fax Number	:	215-332-9337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/17/2020

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