Healthcare Provider Details

I. General information

NPI: 1184566200
Provider Name (Legal Business Name): AHDAL SINGH SEKHON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253C OLD BRIDGE RD
WOODBRIDGE VA
22192-3025
US

IV. Provider business mailing address

15933 CLAYTON RD STE 210
BALLWIN MO
63011-2172
US

V. Phone/Fax

Practice location:
  • Phone: 703-494-8900
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003644
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: