Provider Demographics
NPI:1063480184
Name:DEDHAR, ASGHAR G (OD)
Entity Type:Individual
Prefix:DR
First Name:ASGHAR
Middle Name:G
Last Name:DEDHAR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4007
Mailing Address - Country:US
Mailing Address - Phone:516-794-8185
Mailing Address - Fax:
Practice Address - Street 1:102-22 ATLANTIC AVENUE
Practice Address - Street 2:SAP OPTICAL INC
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416
Practice Address - Country:US
Practice Address - Phone:718-846-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2698488Medicaid
NY05410NMedicare ID - Type Unspecified
NY2698488Medicaid