Healthcare Provider Details

I. General information

NPI: 1982246252
Provider Name (Legal Business Name): RAVNEET KAUR SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W SHAW AVE
FRESNO CA
93704-2816
US

IV. Provider business mailing address

160 LEADERSHIP DRIVE
BRAMPTON ONTARIO
L6Y5T3
CA

V. Phone/Fax

Practice location:
  • Phone: 559-222-0220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34421TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: