=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295393668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. NACHER MOHAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2019
-----------------------------------------------------
Last Update Date | 11/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 - 610 SIXTH STREET
-----------------------------------------------------
City | NEW WESTMINSTER
-----------------------------------------------------
State | BRITISH COLUMBIA
-----------------------------------------------------
Zip | V3L 3C2
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone | 604-522-6929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240-610 SIXTH STREET
-----------------------------------------------------
City | NEW WESTMINSTER
-----------------------------------------------------
State | BRITISH COLUMBIA
-----------------------------------------------------
Zip | V3L3C2
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 3617
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------