Provider Demographics
NPI:1447744263
Name:MINHAS, PREETI (OD)
Entity Type:Individual
Prefix:DR
First Name:PREETI
Middle Name:
Last Name:MINHAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SYLVAN LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1434
Mailing Address - Country:US
Mailing Address - Phone:857-383-8887
Mailing Address - Fax:
Practice Address - Street 1:23 TECHNOLOGY DR STE 5
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4072
Practice Address - Country:US
Practice Address - Phone:631-675-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist