Provider Demographics
NPI:1275827982
Name:DR ANUP K PANJWANI AND ASSOCIATES INC
Entity Type:Organization
Organization Name:DR ANUP K PANJWANI AND ASSOCIATES INC
Other - Org Name:HI DEF EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUP
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:PANJWANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-502-6075
Mailing Address - Street 1:3838 WATKINS MILL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6448
Mailing Address - Country:US
Mailing Address - Phone:904-502-6075
Mailing Address - Fax:904-207-7933
Practice Address - Street 1:3838 WATKINS MILL DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-6448
Practice Address - Country:US
Practice Address - Phone:904-502-6075
Practice Address - Fax:904-207-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003658300Medicaid
FL003658300Medicaid