Provider Demographics
NPI:1457467532
Name:SAPPAL, AMANDIP SINGH (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDIP
Middle Name:SINGH
Last Name:SAPPAL
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 1:15651 SHERIDAN ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3496
Mailing Address - Country:US
Mailing Address - Phone:954-252-8885
Mailing Address - Fax:954-252-8882
Practice Address - Street 1:15651 SHERIDAN ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-3496
Practice Address - Country:US
Practice Address - Phone:954-252-8885
Practice Address - Fax:954-252-8882
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3739152W00000X
CA11485T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68121OtherBLUE CROSS BLUE SHIELD ID
FL68121OtherBLUE CROSS BLUE SHIELD ID