MEDICARE: PUNIT DHALIWAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	15079	CA
2	152WC0802X	Corneal and Contact Management Optometrist	15079	CA
3	152WP0200X	Pediatric Optometrist	15079	CA
4	152WV0400X	Vision Therapy Optometrist	15079	CA

General Provider Information

NPI Number	:	1669881967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUNIT DHALIWAL

Provider Business Mailing Address
First Line	:	8120 TIMBERLAKE WAY STE 211
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5414
Country	:	US
Telephone Number	:	916-423-2134
Fax Number	:	916-423-4477

Provider Business Practice Location Address
First Line	:	8120 TIMBERLAKE WAY STE 211
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5414
Country	:	US
Telephone Number	:	916-423-2134
Fax Number	:	916-423-4477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	06/30/2016

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Directions to “ PUNIT DHALIWAL ” Practice Location

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