MEDICARE: DR. MANJOT K SIDHU 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	7675T	TX

General Provider Information

NPI Number	:	1942504238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANJOT K SIDHU O.D.

Provider Business Mailing Address
First Line	:	8880 STATE HIGHWAY 121
Second Line	:	STE 140
City	:	MCKINNEY
State	:	TX
Zip	:	75070-3132
Country	:	US
Telephone Number	:	469-854-6787
Fax Number	:

Provider Business Practice Location Address
First Line	:	8532 DAVIS BLVD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8300
Country	:	US
Telephone Number	:	817-503-0618
Fax Number	:

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

Provider Enumeration Date	:	01/01/2011
Last Update Date	:	09/16/2021

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