=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801978523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANISHA N. RAVAL O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 03/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2329 COTTMAN AVE ROOSEVELT MALL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19149-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-332-7228
-----------------------------------------------------
Fax | 215-332-9337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RAVAL EYE CARE ASSOCIATES 1495 OLD YORK ROAD
-----------------------------------------------------
City | ABINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19001-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-572-6098
-----------------------------------------------------
Fax | 215-572-6308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001038
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------