Provider Demographics
NPI:1063442234
Name:SANTOSH SINGLA PROFESSIONAL OPTICS
Entity Type:Organization
Organization Name:SANTOSH SINGLA PROFESSIONAL OPTICS
Other - Org Name:PROFESSIONAL OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINGLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-985-7018
Mailing Address - Street 1:3000 39TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5517
Mailing Address - Country:US
Mailing Address - Phone:409-985-7018
Mailing Address - Fax:409-985-2915
Practice Address - Street 1:3000 39TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5517
Practice Address - Country:US
Practice Address - Phone:409-985-7018
Practice Address - Fax:409-985-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7613332B00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019797201Medicaid
TX019797201Medicaid