=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144661372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. HARLIN SINGH SIDHU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2013
-----------------------------------------------------
Last Update Date | 11/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8430 MILLS DR
-----------------------------------------------------
City | KENDALL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-4807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-279-4260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 SE 6TH ST APT 3303
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33131-2560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-803-5526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC4903
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TUV008038-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------