Healthcare Provider Details

I. General information

NPI: 1508437625
Provider Name (Legal Business Name): KEVIN A SINGH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11915 ATLANTIC AVE
RICHMOND HILL NY
11418-3216
US

IV. Provider business mailing address

11915 ATLANTIC AVE
RICHMOND HILL NY
11418-3216
US

V. Phone/Fax

Practice location:
  • Phone: 718-805-0700
  • Fax: 718-805-5621
Mailing address:
  • Phone: 718-805-0700
  • Fax: 718-805-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: