Healthcare Provider Details

I. General information

NPI: 1457542540
Provider Name (Legal Business Name): PAUL SINGH ATWAL PAUL ATWAL, O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N ARBOLEDA DR
MERCED CA
95340-9425
US

IV. Provider business mailing address

560 N ARBOLEDA DR
MERCED CA
95340-9425
US

V. Phone/Fax

Practice location:
  • Phone: 209-726-0729
  • Fax: 209-726-1957
Mailing address:
  • Phone: 209-726-0729
  • Fax: 209-726-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number13349T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: