Healthcare Provider Details

I. General information

NPI: 1215861042
Provider Name (Legal Business Name): SHAUN SINGH DHILLON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE
GROTON CT
06349-2324
US

IV. Provider business mailing address

925 ENTRADA RD
SACRAMENTO CA
95864-5313
US

V. Phone/Fax

Practice location:
  • Phone: 916-761-8544
  • Fax:
Mailing address:
  • Phone: 916-761-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005940
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: