Healthcare Provider Details

I. General information

NPI: 1538987193
Provider Name (Legal Business Name): LUVPREET SINGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MACDADE BLVD
MILMONT PARK PA
19033-3204
US

IV. Provider business mailing address

704 ELENA DR
BROOMALL PA
19008-2726
US

V. Phone/Fax

Practice location:
  • Phone: 610-522-1500
  • Fax:
Mailing address:
  • Phone: 267-324-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004213
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: