Healthcare Provider Details

I. General information

NPI: 1144020314
Provider Name (Legal Business Name): CHANVIR SINGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 BEAVER POND LOOP
MADERA CA
93636-9057
US

IV. Provider business mailing address

956 BEAVER POND LOOP
MADERA CA
93636-9057
US

V. Phone/Fax

Practice location:
  • Phone: 559-779-6940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT36232TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: