Provider Demographics
NPI:1366487118
Name:PANDIT, SUKUMAR (OD)
Entity Type:Individual
Prefix:DR
First Name:SUKUMAR
Middle Name:
Last Name:PANDIT
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 1:1150 1ST AVE
Mailing Address - Street 2:SUITE 805
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1334
Mailing Address - Country:US
Mailing Address - Phone:484-681-2249
Mailing Address - Fax:484-681-2250
Practice Address - Street 1:1150 1ST AVE
Practice Address - Street 2:SUITE 805
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1334
Practice Address - Country:US
Practice Address - Phone:484-681-2249
Practice Address - Fax:484-681-2250
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12928 TPA152W00000X
PAOEG 002556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366487118Medicaid
CA1366487118Medicaid
CABP018YMedicare PIN