MEDICARE: DR. RIDDHI J DESAI O.D.

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	27OA00666700	NJ
2	152W00000X	Optometrist	OEG003688	PA

General Provider Information

NPI Number	:	1811348972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIDDHI J DESAI O.D.

Provider Business Mailing Address
First Line	:	8 WHITSON LN
Second Line	:
City	:	MONROE
State	:	NJ
Zip	:	08831-3792
Country	:	US
Telephone Number	:	201-680-9421
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 LINCOLN FINANCIAL FIELD WAY
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-5305
Country	:	US
Telephone Number	:	201-680-9421
Fax Number	:

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

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	10/19/2021

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