Provider Demographics
NPI:1417632597
Name:SINGH, SHADAANAN
Entity Type:Individual
Prefix:
First Name:SHADAANAN
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 W 53RD AVE UNIT 125
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-6640
Mailing Address - Country:US
Mailing Address - Phone:407-968-4928
Mailing Address - Fax:
Practice Address - Street 1:421 W 104TH AVE STE J
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4139
Practice Address - Country:US
Practice Address - Phone:720-502-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist