1568724318 NPI number — DR. HERSHMINDER DHANOA MANN O.D.

Table of content: DR. HERSHMINDER DHANOA MANN O.D. (NPI 1568724318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568724318 NPI number — DR. HERSHMINDER DHANOA MANN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANN
Provider First Name:
HERSHMINDER
Provider Middle Name:
DHANOA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DHANOA
Provider Other First Name:
HERSHMINDER
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568724318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10355 TRINITY PARKWAY
Provider Second Line Business Mailing Address:
(ATTENTION VISION CENTER)
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-957-3060
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10355 TRINITY PKWY
Provider Second Line Business Practice Location Address:
ATTENTION VISION CENTER
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95219-7243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-957-3060
Provider Business Practice Location Address Fax Number:
209-952-5946
Provider Enumeration Date:
06/07/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18003719B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 18003719A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 14595TPL , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)